Comparison of the effect of web‑based, simulation‑based, and conventional training on the accuracy of visual estimation of postpartum hemorrhage volume on midwifery students: A randomized clinical trial

Masoumeh Kordi, .; Farzaneh Rashidi Fakari, .; Seyed Reza Mazloum, .; Talaat Khadivzadeh, .; Farideh Akhlaghi, .; Mahmoud Tara, .

Comparison of the effect of web‑based, simulation‑based, and conventional training on the accuracy of visual estimation of postpartum hemorrhage volume on midwifery students: A randomized clinical trial

Authors

. Masoumeh Kordi

. Farzaneh Rashidi Fakari

. Seyed Reza Mazloum

. Talaat Khadivzadeh

. Farideh Akhlaghi ¹

. Mahmoud Tara ²

¹ Department of Obstetrics and Gynecology, School of Medicine

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

Abstract

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.

Keywords

Accuracy

postpartum hemorrhage

training

visual estimation

1. Dabbaghi GT, Elmizadeh K, Moradi S, Rashvand ME. Comparison
of intravenous Oxytocin and oral misoprostol in reduction of
Postpartum Hemorrhage. Zanjan Univ Med Sci J 2012;20:1‑8.
2. Yamasaki Y, Morita H, Miyahara Y, Ebina Y, Okada T, Yamaguchi M,
et al. The factors associated with the failure of transcatheter pelvic
arterial embolization for intractable postpartum hemorrhage.
J Perinat Med 2014;42:359‑62.
3. RathWH. Postpartum hemorrhage–update on problems of definitions
and diagnosis. Acta Obstet Gynecol Scand 2011;90:421‑8.
4. Gray cuningham F lO, Steven L, John C, Dwight J, Cathrine Y.
Williams obstetrics. 23th ed. New York: McGraw Hill; 2010:956‑1011.
5. Beigi A, Tabarestani H, Moini A, Zarrinkoub F, Kazempour M.
Sublingual misoprostol versus intravenous oxytocin in the
management of postpartum hemorrhage. Tehran Univ Med J
2009;67:556‑61.
6. Chelmow D. Postpartum haemorrhage: Prevention. Clin
Evid (Online) 2008;12:1410‑48.
7. Aslam M, Ahmed SR, Rajab MT, Nawaz R, Shamim R. Primary
Postpartum Hemorrhage, Still a Big Challenge in Developing
World (Experience in Tertiary care Hospitals, KSA versus Pakistan).
Ann King Edward Med Univ 2013;18:17‑24.
8. Evenson A, Anderson J. Postpartum Hemorrhage. Third Stage
Pregnancy. American Academy of Family Physicians. 2013.
9. Shirazi M, Lotfi M. The mangement of post partum haemorrhage.
J Obstet Gynecol 2010;5:14‑29.
10. Abbaspoor Z, Vaziri I, Emam J. Survey of lochia pattern and some
of factors affect on its period length in women after delivery. Guilan
Univ Med Sci 2007;16:96‑100.
11. Bellad MB, Laxmi BV, Goudar SS, Ashwath Kumar A. Standardized
visual estimation of blood loss during vaginal delivery with its
correlation ematocrit changes. South Asia Fed Obstetr Gynecol
2009;1:29‑34.
12. Shafi F, Maguire P, O’SullivanR, editors. Accuracy of visual estimation
of blood loss at Obstetric haemorrhage by healthcare personnel.
Bjog‑An international Journal of Obstetrics and gyncology.
111riverst, Hoboken 07030‑5774. NJ USA: Willy‑Blackwell; 2013.
p. 438‑9.
13. Kodkany B, Derman R, Sloan N. Pitfalls in assessing blood loss and
decision to transfer. A textbook of postpartum hemorrhage.Duncow,
Kirkmahoe, Dumfrieshire, UK: Sapiens Publishing; 2006. p. 35‑45
14. Akhlaghi F, Taghipour Bazargani V, Jamali J. Visual estimation of
post partum hemorrhage and its treatment. Tehran Univ Med J
2012;70:257‑63.
15. Bagheri M, Moafaghi Z, Asadi F, Haji Abadi F, AsleZare M, Omid M,
Bigdeli M, Dastani M, Davoodi N, ShaghaghiFalah M, KaramiFar N,
Vahid H. Clinical skills competency‑based approach: Understanding
the Basics of Competency‑based training, training manuals and
learning Tehran: Medical Education Development Center. Iran:
University of Mashhad; 2000.
16. Baghaei R, Rasouli D, Rahmani A, Mohammadpour Y, Jafarizadeh H.
Effect of web‑based education on cardiac dysrhythmia learning in
nursing student of Orumieh University of Medical Sciences. Iran J
Med Educ 2012;12:240‑8.
17. Erfanian F, Khadivzadeh T, Khadem N, Khajedelooie M. The Effect
of Teaching by Role Playing on Students’ Counseling and Screening
Skills toward IUD Clients. Iran J Med Educ 2008;8:275‑83.
18. Dadgostarnia M, Vafamehr V. Comparing the Effectiveness of Two
Educational Approaches of “Electronic Learning and Training in
Small Groups” and “Training Only in Small Groups” in Teaching
Physical Examination. Iran J Med Educ 2010;10:11‑7.
19. Healy DG, Fleming FJ, Gilhooley D, Felle P, Wood AE, Gorey T,
et al. Electronic learning can facilitate student performance in
undergraduate surgical education: A prospective observational
study. BMC Med Educ 2005;5:23.
20. Khatoni A, Dehghan Nayery N, Ahmady F, Haghani H. Comparison
the effect of Web‑based Education and Traditional Education on
Nurses Knowledge about Bird Flu in Continuing Education. Iran J
Med Educ 2012;11:140‑8.
21. Cook DA. Web‑based learning: Pros, cons and controversies. Clin
Med 2007;7:37‑42.
22. Toledo P, McCarthy RJ, Burke CA, Goetz K, Wong CA, Grobman WA.
The effect of live and web‑based education on the accuracy of
blood‑loss estimation in simulated obstetric scenarios. Am J Obstet
Gynecol 2010;202:400.e1‑5.
23. Dildy GA 3rd, Paine AR, Geroger NC, Velasco C. Estimating blood
loss: Can teaching significantly improve visual estimation? Obstet
Gynecol 2004;104:601‑6.
24. Razvi K, Chua S, Arulkumaran S, Ratnam S. A Comparison Between
Visual Estimation and Laboratory Detennination of Blood Loss
During the Third Stage of Labour. Aust New Z J Obstet Gynaecol
1996;36:152‑6.
25. Kreutziger J, Haim A, Jonsson K, Wenzel V, Stark M, Nussbaumer W.
Variation in size of blood puddles on different surfaces. Eur J Emerg
Med 2014;21:360‑3.
26. Williams B, Boyle M. Estimation of External Blood Loss by
Paramedics: Is There Any Point? Prehosp Disaster Med 2007;22:502.
27. Sukprasert M, Choktanasiri W, Ayudhya N, Promsonthi P,
O‑Prasertsawat P. Increase accuracy of visual estimation of
blood loss from education programme. J Med Assoc Thai
2006;89(Suppl 4):54‑9.
28. Andersen KM, Avery MD. Faculty teaching time: A comparison of
web‑based and face‑to‑face graduate nursing courses. Int J Nurs
Educ Scholarsh 2008;5:1-12.
29. Gordon JA, Shaffer DW, Raemer DB, Pawlowski J, Hurford WE,
Cooper JB. A randomized controlled trial of simulation‑based teaching
versus traditional instruction in medicine: A pilot study among clinical
medical students. Adv Health Sci Educ Theory Pract 2006;11:33‑9.
30. Moreno‑Ger P, Torrente J, Bustamante J, Fernández‑Galaz C,
Fernández‑Manjón B, Comas‑Rengifo MD. Application of a low‑cost
web‑based simulation to improve students’ practical skills in medical
education. Int J Med Inform 2010;79:459‑67.
31. Merlin MA, Alter SM, Raffel B, Pryor PW 2nd. External blood
loss estimation using the MAR Method. Am J Emerg Med
2009;27:1085‑90.
32. Kang WB. Estimating blood loss: A survey of abilities 2006. J Educ
Perioper Med 2006;8:E041. Available from:http://www.ncbi.nlm.
nih.gov/pmc/articles/PMC4803381/. [Last accessed on 2016 Jun 15].
33. Meiser A, Casagranda O, Skipka G, Laubenthal H. Quantification
of blood loss. How precise is visual estimation and what does its
accuracy depend on?. Anaesthesist 2001;50:13‑20.
34. Amanlou S, Didehdar R. Web‑Based Education in Teaching Medical
Mycology to The Students of Pharmacy in Zabol University of
Medical Sciences in 2009. Iran J Med Edu 2009;11:230‑7.