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Purpose: This study was designed to investigate an accuracy of visual estimation of blood loss and the usefulness of simulation-based educational program for postpartum hemorrhage. Methods: The participants included 12 nurses and 8 residents who were working at Mother and Baby Center of Ewha Womans University Hospital. A simulation-based education for estimation of blood loss was conducted for all of the participants. Tests were performed before and after simulation-based education. Two additional tests were performed two and four weeks after the education. Self-confidence score for blood loss estimation was also investigated by questionnaire. Results: Significant underestimation was observed in all questions of 450, 700, and 1,100 mL. Median for percent errors of each questions were -50%, -29%, and -9%, respectively. After simulation-based education, accuracy was improved with the medians of -5%, 0%, and 13%. Selfconfidence score in visual estimation of blood loss was also improved significantly after the education. There were no differences by profession or work experience. Conclusion: Significant underestimation was seen before simulation-based education. This study shows that the accuracy of visual blood loss estimation was improved after education. Accurate estimation of blood loss will contribute to a timely diagnosis and resuscitation in postpartum hemorrhage. Our study suggests that periodic education for visual estimation of blood loss in obstetrical hemorrhage might improve accuracy and clinical outcome.

Efficacy of Simulation-based Learning for Improving the Accuracy of Blood Loss Estimation in Postpartum Hemorrhage