培训后目测法评估阴道分娩出血量准确性的前瞻性研究

The Accuracy of Visual Assessment for Estimating Blood Loss of Vaginal Delivery after Training:A Prospective Study

目的:探讨培训后目测法用于评估阴道分娩出血量的准确性。方法:前瞻性纳入2013年1月至2014年1月在四川大学华西第二医院经阴道分娩的孕妇2459例,比较培训后目测法和称重法评估阴道分娩出血量的差异。结果:产后出血的发生率为4.39%。目测法评估阴道分娩出血量比称重法高估10.1%,差异有统计学意义(P<0.05)。在高估部分病例中,医生高估的阴道分娩出血量明显多于助产士(P<0.01)。在总体和低估部分病例中,未发现差值与工作年限的相关性;在高估部分病例中,差值和工作年限呈负相关(r=-0.107,P<0.01)。结论:培训后目测法评估阴道分娩出血量与称重法比较仍有差异,且以高估为主,但是仍有低估的发生。推荐尽量使用称重法评估阴道分娩出血量,无法称重的部分使用目测法进行评估。

Objective.To explore the accuracy of visual assessment for estimating blood loss of vaginal delivery after training. Methods;We carried out a prospective study including two thousands four hundred and fifty nine women who choosed vaginal delivery at West China Second Hospital, Sichuan University from January 2013 to January 2014. Comparison between visual assessment after training and gravimetric measurement for estimating blood loss was carried out. Results： The incidence of postpartum hemorrhage was 4. 39%. There was significant difference between the visual assessment and the gravimetric measurement with a tendency to overestimate the loss by 10. 1% （ P 〈 0. 05）. In the overestimate part, the volumes overestimated by doctor were more than those overestimated by midwife （ P 〈 0.01 ）. The one, who worked longer time,seems to be more accurate（ r = - 0. 107, P 〈 0.01 ）. However, in the underestimate part,there was no significant difference among different work time groups. Conclusions=The accuracy of visual assessment is improved after training and most of visual assessment is overestimated. But there is still someone＇s blood loss volume is underestimated. So we still recommend estimating the blood loss of vaginal delivery by gravimetric measurement as possible as we could,and visual assess the volumes that can＇t be gravimetric. While it＇s in need to train the doctor and midwife for improving the accuracy of visual assessment.