Saving Lives with Simulation Training in QBL and PPH Recognition

| Roxanne Blanford

The CAE Lucina childbirth simulator is unique in many ways, not least of which is the ability to train learners on quantification of blood loss (QBL) for recognizing and treating postpartum hemorrhage (PPH).

It’s perfectly normal to experience some blood loss during childbirth as the placenta separates from the uterus, and to lose more blood from open blood vessels immediately following delivery. However, up to six percent of women have excessive blood loss (postpartum hemorrhage, or PPH) when the uterus fails to contract after birth.

According to the World Health Organization (WHO) obstetric hemorrhage is the leading cause of maternal morbidity worldwide. Quantification of Blood Loss (QBL) is an effective method for evaluating excessive bleeding.

Guest blogger, CAE Healthcare Adjunct Faculty Karla Olson, (RN, MSN, RNC-OB, C-EFM, CBC, CLNC) offers the following insights into this major crisis in women’s healthcare with a focus on simulation-based training with CAE Fidelis Lucina for quantifying blood loss, detecting a life-threatening hemorrhage and improving clinical outcomes.

Maternal mortality from blood loss occurs when postpartum hemorrhage (PPH) is not recognized early, and effective interventions are not initiated in time. Simulation practice provides several training opportunities for understanding the dynamics of PPH so that medical teams may respond appropriately, and save lives.

Uterine Massage: The ability to palpate and perform an effective uterine massage is the first step in the treatment of PPH. If a uterine massage is not effective, the uterus will not contract (and bleeding will continue).

  • Lucina has internal sensors that are engineered to recognize and respond to effective uterine massage.

Uterine Atony: Initial assessment of uterine atony to determine whether the uterus is firmly contracted can be modeled with this simulator.

  • Lucina can be programmed to present a firm uterus. Fifteen minutes later, she could present with a boggy uterus and bleed at various rates.

Placental Examination: Examination of the placenta for retained fragments is a routine procedure for all deliveries.

  • Lucina has both an intact and fragmented placenta for all aspects of training and learning to recognize the signs of postpartum hemorrhage.

Uterine Tamponade: Placement of the tamponade balloon is a high risk, low frequency procedure used in the case of intractable uterine atony.

  • Lucina’s uterus is capable of uterine tamponade by the placement of an intrauterine balloon device, allowing the learner to become proficient in this potentially lifesaving procedure.

QBL with Fidelis Lucina: Simulation gives learners practice in recognizing and quantifying maternal blood loss. They can then assess how rapidly they must respond with uterine massage, and/or the use of uterotonic agents.

  • Lucina’s vaginal bleeding reservoir holds two liters of fluid and blood loss is modeled on true physiology. Appropriate changes occur in Lucina’s heart rate, blood pressure, and respiratory parameters for a more realistic and intense training experience.

The postpartum uterus features and programmed physiology of the Lucina simulator can successfully train on life-saving QBL and PPH recognition in a safe and controlled environment, instilling clinical thinking and reaction skills that may be effectively transferred to real life situations.

AWHONN (the Association of Women’s Health, Obstetric, and Neonatal Nurses) has released a series of clinical practice videos on maternal and neonatal care.

> > View the AWHONN "Quantification of Blood Loss" video here


Karla Olson, RN, MSN, RNC-OB, C-EFM, CBC, CLNC is an active Registered Nurse, Certified Perinatal Education Instructor, ACLS provider and AWHONN Instructor for Electronic Fetal Monitoring with decades of experience in inpatient obstetrics, labor & delivery, NICU, pediatrics, and hospital education. Ms. Olson has presented on obstetric emergencies, perinatal nursing, and critical thinking for nurses, and is the co-author of medical-related publications for the Sarasota Memorial Health Care System, in Sarasota Florida.



Cochrane Database Syst Rev. 2013 Jul 1;7:CD006431. doi: 10.1002/14651858.CD006431.pub3.
Hofmeyr GJ, Abdel-Aleem H, Abdel-Aleem MA. Uterine massage for preventing postpartum haemorrhage.
World Health Organization. Maternal Mortality in 2000: Estimates by WHO, UNICEF, UNFPA. Geneva: World Health Organization; 2004.

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