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Iran J Nurs Midwifery Res. 2015 Jul-Aug;20(4):471-5. doi: 10.4103/1735-9066.161005.

Comparing the estimation of postpartum hemorrhage using the weighting method and National Guideline with the postpartum hemorrhage estimation by midwives.

Author information

Department of Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
Department of Midwifery, Islamic Azad University, Neyshabur Branch, Neyshabur, Iran.
Department of Obstetrics and Gynecology, Omolbanin Hospital, Mashhad, Iran.
Department of Mathematics, Hormozgan University of Basic Sciences, Bandarabas, Iran.
Department of Midwifery, Mashhad University of Medical Sciences, Midwife, Omolbanin Hospital, Mashhad, Iran.



In developing countries, hemorrhage accounts for 30% of the maternal deaths. Postpartum hemorrhage has been defined as blood loss of around 500 ml or more, after completing the third phase of labor. Most cases of postpartum hemorrhage occur during the first hour after birth. The most common reason for bleeding in the early hours after childbirth is uterine atony. Bleeding during delivery is usually a visual estimate that is measured by the midwife. It has a high error rate. However, studies have shown that the use of a standard can improve the estimation. The aim of the research is to compare the estimation of postpartum hemorrhage using the weighting method and the National Guideline for postpartum hemorrhage estimation.


This descriptive study was conducted on 112 females in the Omolbanin Maternity Department of Mashhad, for a six-month period, from November 2012 to May 2013. The accessible method was used for sampling. The data collection tools were case selection, observation and interview forms. For postpartum hemorrhage estimation, after the third section of labor was complete, the quantity of bleeding was estimated in the first and second hours after delivery, by the midwife in charge, using the National Guideline for vaginal delivery, provided by the Maternal Health Office. Also, after visual estimation by using the National Guideline, the sheets under parturient in first and second hours after delivery were exchanged and weighted. The data were analyzed using descriptive statistics and the t-test.


According to the results, a significant difference was found between the estimated blood loss based on the weighting methods and that using the National Guideline (weighting method 62.68 ± 16.858 cc vs. National Guideline 45.31 ± 13.484 cc in the first hour after delivery) (P = 0.000) and (weighting method 41.26 ± 10.518 vs. National Guideline 30.24 ± 8.439 in second hour after delivery) (P = 0.000).


Natural child birth education by using the National Guideline can increase the accuracy of estimated blood loss. Therefore, training the personnel to use this guideline is recommended. However, It has less accuracy than 'sheet weighing'. Consequently, usage of symptoms and the weighing method is recommended in cases of postpartum bleeding.


Gravimetric method; National Guideline; hemorrhage estimation; midwife; postpartum hemorrhage

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