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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 investigate the accuracy of post-training visual assessment of vaginal delivery bleeding. Methods: 2459 pregnant women who delivered vaginally from January 2013 to January 2014 in West China Second Hospital of Sichuan University were prospectively included in this study. The differences of vaginal bleeding after delivery were assessed by visual inspection and weighing method. Results: The incidence of postpartum hemorrhage was 4.39%. Visual assessment of vaginal delivery of bleeding than the weighing method overestimated 10.1%, the difference was statistically significant (P <0.05). In the overestimation of some cases, doctors over-estimated vaginal delivery of bleeding was significantly more than midwives (P <0.01). In the overall and underestimated partial cases, no correlation was found between the difference and the number of working years; in some cases, the difference was negatively correlated with the working years (r = -0.107, P <0.01). Conclusion: After training, visual assessment of vaginal delivery of blood loss compared with the weighing method is still different, and to overestimate, but there are still underestimated. We recommend that as far as possible to assess the use of weighing method of vaginal delivery of bleeding, can not be weighed part of the visual assessment.