探讨目测法和血红蛋白检测法，评估孕妇在胎儿娩出后24 h内的产后出血(PPH)量的准确性。

选择2012年1月至2013年1月，于成都市妇女儿童中心医院产科住院分娩的332例产妇为研究对象。按照分娩方式，将其分别纳入剖宫产组(n＝186)及阴道分娩组(n＝146)。①对2组受试者的一般临床资料进行比较。②分别采用目测法与血红蛋白检测法，评估2组受试者在胎儿娩出后24 h内的PPH量，并进行统计学分析。③分别采用目测法与血红蛋白检测法，评估2组受试者的PPH发生率，并进行统计学分析。④计算血红蛋白(Hb)水平每下降10 g/L时，受试者的PPH量。本研究遵循的程序符合成都市妇女儿童中心医院人体试验委员会制定的伦理学标准，得到该委员会批准，分组征得受试者知情同意，并与受试者本人签署临床研究知情同意书。

①2组受试者的年龄、孕次、产次、分娩孕龄、分娩前体重，以及新生儿出生体重、身长等一般临床资料比较，差异均无统计学意义(P>0.05)。②目测法评估剖宫产组与阴道分娩组受试者在胎儿娩出后24 h内的PPH量，分别为380.0 mL(348.8～406.3 mL)和274.5 mL(220.0～331.1 mL)，剖宫产组胎儿娩出后24 h内的PPH量，显著多于阴道分娩组，2组比较，差异有统计学意义(H＝84.4，P<0.001)。2组胎儿娩出后24 h时，在Hb水平低于产前1 d的Hb水平的142例与121例受试者中，分别采用血红蛋白检测法评估剖宫产组与阴道分娩组胎儿娩出后24 h内的PPH量中位数，分别为340.2 mL(170.1～539.5 mL)和377.1 mL(103.1～652.8 mL)，阴道分娩组胎儿娩出后24 h内的PPH量，显著多于剖宫产组，2组比较，差异亦有统计学意义(H＝6.6，P<0.001)。③2组胎儿娩出后24 h时，Hb水平低于产前1 d的Hb水平的263例受试者中，目测法估计PPH发生率，在剖宫产组与阴道分娩组及所有受试者中，均显著低于血红蛋白检测法，差异均有统计学意义(χ²＝21.4、45.6、64.0，均为P<0.001)。④Hb水平每下降10 g/L，受试者PPH量为374.9 mL(330.0～419.6 mL)。

血红蛋白检测法估计受试者在胎儿娩出后24 h内的PPH量，较目测法更为准确，但单独使用血红蛋白检测法估计PPH量具有一定局限性。

To compare the accuracy of visual observation method and hemoglobin assay method in estimation of volume of postpartum hemorrhage (PPH).

A total of 332 cases of pregnant women delivered in Department of Obstetrics, Chengdu Women and Children′s Hospital, from January 2012 to January 2013 were included in the study. They were divided into two groups according to the modes of delivery: cesarean section group (n=186) and vaginal delivery group (n=146). ①General clinical data between 2 groups were analyzed by stastical methods. ②Volumes of PPH within 24 h after delivery between 2 groups were evaluated by visual observation method and hemoglobin assay method, respectively. ③Incidence rates of PPH between 2 groups were evaluated by visual observation method and hemoglobin assay method, respectively. ④The volume of PPH were calculated when per 10 g/L of hemoglobin (Hb) level decreased. The study protocol was approved by the Ethical Review Board of Investigation in Human Beings of Chengdu Women and Children′s Central Hospital. Informed consent was obtained from each participating patient.

①There were no significant differences between 2 groups of pregnant women in the aspects of maternal age, gravidity and parity, gestational age, weight before birth, and birth weight and length of the neonates (P>0.05). ②The volumes of PPH within 24 h after delivery in cesarean section group and vaginal delivery group evaluated by visual observation method were 380.0 mL (348.8-406.3 mL) and 274.5 mL(220.0-331.1 mL), respectively. The median volume of PPH within 24 h after delivery of cesarean section group evaluated by visual observation method was significantly higher than that of vaginal delivery group, and the difference was statistically significant (H=84.4, P<0.001). The volumes of PPH within 24 h after delivery of 142 and 121 cases with Hb level decreased in cesarean section group and vaginal delivery group evaluated by the hemoglobin assay method were 340.2 mL (170.1-539.5 mL) and 377.1 mL (103.1-652.8 mL), respectively. The volumes of PPH within 24 h after delivery in vaginal delivery group evaluated by hemoglobin assay method was significantly higher than that of cesarean section group, and the difference was statistically significant (H=6.6, P<0.001). ③The incidence rates of PPH estimated by visual observation method in cesarean section group and vaginal delivery group, and in the 263 cases of pregnant women with Hb levels decrease, were significantly lower than those of hemoglobin assay method, and the differences were statistically significant (χ²=21.4, 45.6, 64.0; P<0.001). ④When per 10 g/L of Hb level decrease, the median volume of PPH within 24 h after delivery was 374.9 mL (330.0-419.6 mL).

The hemoglobin assay method provides more accurate estimates of volume of PPH within 24 h after delivery than that of the visual observation method, but it has limitations to estimate the volume of PPH by hemoglobin assay method alone.