Live or Web-based training improves clinical estimates of blood loss during childbirth
Research Activities, October 2010, No. 362
Training labor and delivery personnel to visually estimate blood loss, either live or via the Web, can improve the accuracy of blood loss estimation in postpartum hemorrhage, concludes a new study. Visually estimating the volume of blood lost during delivery is routinely used to evaluate the seriousness of maternal bleeding, but can overestimate small volumes of blood and underestimate large ones. Postpartum hemorrhage, defined as >500 mL blood loss for a vaginal delivery or >1,000 mL for a cesarean delivery, is seen in 1-5 percent of all deliveries in the United States, and is a leading cause of maternal mortality in the United States and worldwide. It can lead to shock, disseminated intravascular coagulation, or even death, if not diagnosed and treated early.
The training program involved all labor and delivery unit providers at a Chicago hospital, as part of the hospital's quality initiative. Of the 372 providers participating in the study, 231 underwent live training and 141 underwent Web-based training. In the live training, participants took a pretest by going to a room with five stations with premeasured small- and large-volume blood spills and writing down an estimate for each station. The participants then reviewed an educational slide presentation with one of the study investigators. The presentation included the volume of common containers of different sizes, the saturation capacities of different sponges, and methods to estimate the volume of floor spills and blood loss on the delivery bed. Another room held a five-station posttest using different blood volumes. Participants who took the Web-based training were asked to estimate the blood loss from photographs of the pretest stations, went through the educational training online, and estimated the blood loss using photographs of one of the posttest station sets used in the live training. Posttraining estimates of blood loss improved by a significant 34 percent compared with pretraining estimates. This did not differ significantly between live- and Web-based sessions. The study was funded in part by the Agency for Healthcare Research and Quality (T32 HS00078).
More details are in "The effect of live and web-based education on the accuracy of blood-loss estimation in simulated obstetric scenarios," by Paloma Toledo, M.D., Robert J. McCarthy, Pharm.D., Carol A. Burke, M.S.N., R.N.C., A.P.N., and others in the April 2010, American Journal of Obstetrics & Gynecology 202(4), pp. 400.e1-400.e5.