Understanding How Health Providers Identify Women with Postpartum Hemorrhage: A Qualitative Study

Abstract Objective To identify how health providers recognize postpartum hemorrhage early and the difficulties involved in it. Methods An exploratory, descriptive study using a qualitative approach through a semi-structured interview technique. In total, 27 health professionals (nursing tech nicians, nurses, medical residents in Gynecology and Obstetrics, hired medical doctors, and medicine professors) working in a tertiary-level hospital of reference in women’s health care in the State of São Paulo, Brazil, participated in the study through an invitation. After they accepted the invitation, they signed the free and informed consent form. All interviews were recorded and transcribed, and a thematic analysis was conducted. We found three analysis categories: a) perception of the severity: “there is something wrong with the women”; b) difficulties in the early diagnosis of postpartum hemorrhage; and c) the process to improve obstetrical care. Results Caregivers believe teamwork and communication should be improved. Besides the visual estimation of blood loss, the nursing team is attentive to behavioral symptoms like irritability, while the medical staff follow protocols and look for objective signs, such as altered vital signs. Conclusion Besides the objective evaluations, the subjective perceptions of the providers are involved in the clinical judgement regarding the diagnosis of postpartum hemorrhage, and this should be included in a broader diagnosis strategy.

摘要 研究目的：明确医疗服务人员早期识别产后出血（postpartum hemorrhage）的方式及其面临的临床难点。
研究方法：本研究为探索性描述性研究，采用质性研究范式，运用半结构化访谈法开展。研究通过邀约方式，招募巴西圣保罗州某女性医疗保健三级转诊医院的27名医疗专业人员参与，涵盖护理技术员、注册护士、妇产科住院医师、聘用医师及医学教授。受试者确认参与后签署了自愿知情同意书。所有访谈均进行录音与转录，并开展主题分析。本研究共提炼出三类分析范畴：a）病情严重程度认知："该产妇存在异常状况"；b）产后出血早期诊断难点；c）产科护理优化路径。
研究结果：医护人员认为团队协作与沟通有待加强。除目视估算失血量外，护理团队还会关注产妇烦躁等行为症状，而医师团队则遵循诊疗规范，着重观察生命体征异常等客观体征。
研究结论：在产后出血的临床诊断决策中，除客观评估手段外，医疗服务人员的主观感知同样参与临床判断，这一发现应被纳入更全面的诊断策略体系。