Blood Loss Challenge: Are You Ready to Rethink the Estimate?   

Published Aug 14, 2025

Guesswork vs. precision — let’s close the gap. Join the Quantitative Blood Loss vs. Estimated Blood Loss Challenge, empowering birthing providers to champion accuracy, elevate care and improve outcomes. 

Hemorrhage is the sixth leading underlying cause of pregnancy-related death in Missouri and a significant contributor to severe maternal morbidity.  Morbidity and mortality related to hemorrhage are highly preventable. 

That’s where this challenge comes in.  

Who can participate?

All Missouri PQC-participating hospital teams 

What will you do?

• Engage staff in Quantification of Blood Loss process 
• Understand how to calculate QBL 
• Recognize the value in QBL compared to estimation of blood loss (EBL) 
• Achieve commitment to the process 

Where will this take place?

At your facility (in situ simulation) 

How do you participate?

• Set up simulation of blood-soaked items for staff to visually estimate (EBL) and then weigh items (QBL). 
• Record both EBL and QBL. 
• Review findings and debrief with team. 

What items do you need to get started?

• Gram scale 
• Laps, chux, peripads, linens, etc. 
• Fake blood (clear dawn dish soap and red food coloring works well) 
• QBL worksheet with list of items’ dry weights (wet weight – dry weight = QBL) 
• Calculator 
• Worksheet to record EBL and QBL 

Share your findings with the PQC team.

• Photos 
• Staff Feedback  
• Worksheets 

Additional resources are available here.

Submit your findings here to [email protected]. 

Questions? Contact us.

• Katie Brassfield | PQC Project Manager | [email protected] 
• Laura Warren-Hughes | Director of Maternal Quality | [email protected] 
• Morgan Nesselrodt | PQC Specialist – Bootheel Region | [email protected] 

Fast Facts About EBL and QBL

• EBL increases the likelihood of underestimating large volumes of blood loss and overestimating small volumes of blood loss (AWHONN, 2021). Specifically, EBL underestimates large volumes by 33-50% (Lagrew et al., 2022). 
• Root cause analyses from maternal mortality reviews repeatedly identified missed or delayed diagnosis and delays in initiating treatment when EBL was used (ACOG, 2019). 
• Implementation of obstetric hemorrhage bundles including QBL have been found to significantly reduce maternal morbidity (ACOG, 2019). 
• QBL contributes to earlier use of uterotonics when indicated and a reduction of blood transfusions, which lead to better patient outcomes (Katz et al., 2019).