• Wei-Hong Zhang, Catherine Deneux-Tharaux, Peter Brocklehurst, Edmund Juszczak, Matthew Joslin, Sophie Alexander, and EUPHRATES Group.
• Perinatal Epidemiology Research Unit, School of Public Health, Université Libre de Bruxelles, Route de Lennik 808, CP 597, B-1070 Bruxelles, Belgium. wzhang@ulb.ac.be
• BMJ. 2010 Jan 1;340:c293.

ObjectiveTo evaluate the effectiveness of the systematic use of a transparent plastic collector bag to measure postpartum blood loss after vaginal delivery in reducing the incidence of severe postpartum haemorrhage.DesignCluster randomised trial.Setting13 European countries.Participants78 maternity units and 25 381 women who had a vaginal delivery.InterventionsMaternity units were randomly assigned to systematic use of a collector bag (intervention group) or to continue to visually assess postpartum blood loss after vaginal delivery (control group).Main Outcome MeasuresThe primary outcome was the incidence of severe postpartum haemorrhage in vaginal deliveries, defined as a composite of one or more of blood transfusion, intravenous plasma expansion, arterial embolisation, surgical procedure, admission to an intensive care unit, treatment with recombinant factor VII, and death.ResultsSevere postpartum haemorrhage occurred in 189 of 11 037 of vaginal deliveries (1.71%) in the intervention group compared with 295 of 14 344 in the control group (2.06%). The difference was not statistically significant either in individual level analysis (adjusted odds ratio 0.82, 95% confidence interval 0.26 to 2.53) or in cluster level analysis (difference in weighted mean rate adjusted for baseline rate 0.16%, 95% confidence interval -0.69% to 1.02%).ConclusionCompared with visual estimation of postpartum blood loss the use of a collector bag after vaginal delivery did not reduce the rate of severe postpartum haemorrhage.Trial RegistrationCurrent Controlled Trials ISRCTN66197422.

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