1 Department of Obstetrics and Gynecology, School of Medicine

2 Department of Medical Informatics Group, Mashhad University of Medical Sciences, Mashhad, Iran


Introduction: Delay in diagnosis of bleeding can be due to underestimation of the actual
amount of blood loss during delivery. Therefore, this research aimed to compare the efficacy
of web‑based, simulation‑based, and conventional training on the accuracy of visual estimation
of postpartum hemorrhage volume. Materials and Methods: This three‑group randomized
clinical trial study was performed on 105 midwifery students in Mashhad School of Nursing and
Midwifery in 2013. The samples were selected by the convenience method and were randomly
divided into three groups of web‑based, simulation‑based, and conventional training. The three
groups participated before and 1 week after the training course in eight station practical tests,
then, the students of the web‑based group were trained on‑line for 1 week, the students of the
simulation‑based group were trained in the Clinical Skills Centre for 4 h, and the students of
the conventional group were trained for 4 h presentation by researchers. The data gathering
tool was a demographic questionnaire designed by the researchers and objective structured
clinical examination. Data were analyzed by software version 11.5. Results: The accuracy of
visual estimation of postpartum hemorrhage volume after training increased significantly in
the three groups at all stations (1, 2, 4, 5, 6 and 7 (P = 0.001), 8 (P = 0.027)) except station
3 (blood loss of 20 cc, P = 0.095), but the mean score of blood loss estimation after training did
not significantly different between the three groups (P = 0.95). Conclusion: Training increased
the accuracy of estimation of postpartum hemorrhage, but no significant difference was found
among the three training groups. We can use web‑based training as a substitute or supplement
of training along with two other more common simulation and conventional methods.


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