背景:产后出血(PPH)是低收入国家孕产妇死亡和许多高收入国家孕产妇严重发病率的主要原因。PPH后的不良结果通常归因于PPH的识别和治疗延迟。专家建议,提高失血量估计的准确性和可靠性是预防PPH死亡和发病的关键步骤。然而,关于如何实现这一目标几乎没有任何指导。这篇综合综述的目的是评估分娩期间评估产妇失血的各种方法。
方法:系统,对已发表的研究进行了综合审查。所有类型的研究都包括在内,如果它们发展了,tested,或旨在改善分娩过程中失血量的方法和技能,或探索参与这一过程的人的经验。
结果:包括36项研究,这些研究评估了视觉估计的准确性;测试了提高测量技能的方法;检查了它们对PPH诊断和治疗的影响,和/或探索与失血评估相关的其他因素。该评论发现,卫生专业人员在估计失血量方面非常不准确。培训导致技能的短期改善,但这些没有保留,也没有改善临床结果。多方面干预改变了一些临床实践,但并未减少严重PPH的发生率或对过度出血的反应时机。采血袋提高了评估的准确性,但不能防止严重PPH的延迟或进展。从业者通常使用血液流动的性质和速度,以及该妇女的状况表明失血异常。
结论:PPH的早期诊断可以改善产妇结局,但是几乎没有证据表明这可以通过提高失血量测量的准确性来实现。诊断可能依赖于体积以外的因素,例如血液流动的速度和损失的性质。需要改变未来研究的方向,以更详细地探讨这些问题。
BACKGROUND: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality in low-income countries and severe maternal morbidity in many high-income countries. Poor outcomes following PPH are often attributed to delays in the recognition and treatment of PPH. Experts have suggested that improving the accuracy and reliability of blood loss estimation is the crucial step in preventing death and morbidity from PPH. However, there is little guidance on how this can be achieved. The aim of this integrative
review was to evaluate the various methods of assessing maternal blood loss during childbirth.
METHODS: A systematic, integrative
review of published research studies was conducted. All types of studies were included if they developed, tested, or aimed to improve methods and skills in quantifying blood loss during childbirth, or explored experiences of those involved in the process.
RESULTS: Thirty-six studies were included that evaluated the accuracy of visual estimation; tested methods to improve skills in measurement; examined their effect on PPH diagnosis and treatment, and / or explored additional factors associated with blood loss evaluation. The
review found that health professionals were highly inaccurate at estimating blood loss as a volume. Training resulted in short term improvements in skills but these were not retained and did not improve clinical outcomes. Multi-faceted interventions changed some clinical practices but did not reduce the incidence of severe PPH or the timing of responses to excessive bleeding. Blood collection bags improved the accuracy of estimation but did not prevent delays or progression to severe PPH. Practitioners commonly used the nature and speed of blood flow, and the condition of the woman to indicate that the blood loss was abnormal.
CONCLUSIONS: Early diagnosis of PPH should improve maternal outcomes, but there is little evidence that this can be achieved through improving the accuracy of blood loss volume measurements. The diagnosis may rely on factors other than volume, such as speed of blood flow and nature of loss. A change in direction of future research is required to explore these in more detail.