PBLAC is a chart that works by recording a count for each type of sanitary pad used and its degree of soaking as depicted in a pictorial example along with the count and size of blood clots. The intention was to pool the results of identified studies using meta-analysis. The primary outcome was the diagnostic accuracy of PBLAC compared to objective measurements of MBL. In addition, the bibliographies of the retrieved articles and recent reviews were used to identify additional studies. The search was designed and conducted with the help of an experienced librarian. Only studies that compared PBLAC to alkaline hematin were included in the review. In this search, terms referring to “menorrhagia,” “menstrual blood loss evaluation,” and “pictorial chart” were used. The objective of the search was to identify all published reports on the evaluation of menstrual blood loss in humans. Systematic search strategy and study selectionĪ systematic search of MEDLINE, EMBASE, Cumulative Index to Nursing & Allied Health Literature (CINAHL), Web of Science, and EBM Reviews-Cochrane Central Register of Controlled Trials from inception until Septemwas performed. This systematic review was reported in accordance with the Meta-analysis of Observational Studies in Epidemiology recommendation and the Standards for Reporting of Diagnostic Accuracy initiatives and the guidelines for conducting systematic reviews of diagnostic studies. The objective of this systematic review is to evaluate the diagnostic accuracy of PBLAC in evaluating MBL. Nonetheless, there is conflicting evidence about its accuracy. Recently, PBLAC has been increasingly used in clinical research especially pivotal trials that evaluated the effectiveness of non-hysteroscopic-dependent endometrial ablation devices. The pictorial blood assessment chart (PBLAC) is a semi-quantitative method for evaluation of MBL that was first published by Higham and Shaw in 1990 and improved and validated by Janssen and colleagues in 1995 (Fig. Despite this early interest, to date, there is no tool in current clinical practice that is easy to use, has good correlation with patient complaint, and can detect change in menstruation after treatment. In 1936, Barer and Fowler from the University of Iowa reported the results of assessment of MBL in 100 women and performed a review of the literature in which they identified 32 publications reporting on the previously proposed amount for “normal” MBL. One of the first reports dates back to 1904, when Hoppe-Seyler and colleagues reported on the use of acid hematin in quantifying MBL. Although diagnostic testing was not always supportive in terms of sensitivity, specificity, and LRs, most studies support the use of PBLAC as a semi-objective method that can be implemented in research and clinical practice.Įvaluation of menstrual blood loss (MBL) has evoked an insisting debate for gynecologic researchers and clinicians since the early twentieth century. Diagnostic odds ratio ranged from 2.6 to 86.9. Compared to alkaline hematin, PBLAC sensitivity and specificity ranged from 58 to 98 % and 7.5 to 97 %, respectively, with likelihood ratios (LR) for positive ranging from 1.1 to 7.8 and LR for negative tests ranging from 0.04 to 0.48. Out of 255 reports identified by the primary search, seven reports were included in the review. The ability of PBLAC to predict significant blood loss, compared to alkaline hematin as a standard objective method, represents our primary outcome. Terms referring to “pictorial blood loss assessment chart,” “menstrual blood loss evaluation,” and “alkaline hematin” were used. To evaluate the diagnostic accuracy of pictorial blood loss assessment chart (PBLAC) compared to objective measurements of menstrual blood loss (MBL), a systematic search of MEDLINE, EMBASE, Cumulative Index to Nursing & Allied Health Literature (CINAHL), Web of Science, and EBM Reviews-Cochrane Central Register of Controlled Trials from inception until Septemwas performed.

Pictorial chart