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Elfors FB, Widarsson M, Velandia M. Midwives' experiences of postpartum haemorrhage: A web-based survey in Sweden. Midwifery 2024; 129:103902. [PMID: 38064780 DOI: 10.1016/j.midw.2023.103902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 11/09/2023] [Accepted: 11/29/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVE The objective was to describe midwives' experiences of postpartum haemorrhage (PPH) >1000 ml in connection with childbirth. DESIGN A qualitative web-based survey with open-ended questions was used and the results were analysed with content analysis. SETTING Participants were recruited through convenience sampling from a national Facebook group for midwives. PARTICIPANTS The study sample included 24 midwives with varying work experience at different maternity units in Sweden, all of whom had experience of postpartum haemorrhage >1000 ml. FINDINGS The midwives described that the treatment of PPH is limited by a lack of cooperation, knowledge, and assistance, as well as by staff inexperience. They also described how a high-pressure work environment contributed to feelings of inadequacy. Good cooperation, team training, having colleagues present, embodied knowledge, and good working conditions, led to successful handling of such situations, which contributed to feeling at ease with what had happened. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Good working conditions related to external contextual factors such as total load and support, as well as internal factors such as self-efficacy, can help midwives manage PPH while providing patient-safe care and feeling confident in their ability and at ease with the events. Therefore, midwives need to be given opportunities for emotional support, education, and team-based training to maintain the quality of midwifery care and avoid negative long-term effects for both midwives and patients.
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Affiliation(s)
| | - Margareta Widarsson
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Marianne Velandia
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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Lee JS, Day G, Valentino D, Hedges C, Decker C, Booth J, Lockey R, Schroeppel TJ. Help a mother out: The impact of acute care surgeon response in postpartum hemorrhage. Am J Surg 2023; 226:882-885. [PMID: 37532591 DOI: 10.1016/j.amjsurg.2023.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/03/2023] [Accepted: 07/22/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION A Code White (CW) activation is a hospital-wide alert for postpartum hemorrhage (PPH) and acute care surgeons (ACS) were added to the response team to assist in resuscitation. A multidisciplinary training program was also implemented. This study aimed to evaluate the impact of ACS involvement and training on maternal outcomes. METHODS A retrospective review was performed on all CW activations from 1/1/2015-8/31/2022. Three groups-pre-ACS response, ACS response, and ACS response + training (R&T)-were compared. RESULTS 218 patients had CW activations. ACS response increased MTP activations (50.0%vs76.5%vs76.2%, p = 0.014) and TXA administration (50.0%vs96.5%vs93.3%, p < 0.0001). The ACS R&T had the highest ACS presence (53.6%vs72.9%vs96.2%, p < 0.0001), shortest operation (99 vs 67 vs 53min, p = 0.002), lowest crystalloid use (2000 vs 1110 vs 800 ml, p = 0.003), and lowest transfusion requirements. Mortality decreased from 17.9% in pre-ACS to 2.4% in ACS response and 0% in ACS R&T (p < 0.0001). CONCLUSION ACS assistance in CW activations and multidisciplinary PPH education led to the prevention of maternal mortality. ACS are a valuable resource in this unique population.
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Affiliation(s)
- Janet S Lee
- Department of Trauma and Acute Care Surgery, University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA; Department of Surgery, University of Colorado, Aurora, CO, USA.
| | - Gregory Day
- Department of Trauma and Acute Care Surgery, University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA.
| | - Daniel Valentino
- Department of Trauma and Acute Care Surgery, University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA.
| | - Caroline Hedges
- Department of Obstetrics and Gynecology, University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA.
| | - Cassie Decker
- Department of Trauma Research, University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA.
| | - Jessica Booth
- Department of Anesthesiology, University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA.
| | - Renee Lockey
- Department of Obstetrics and Gynecology, University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA.
| | - Thomas J Schroeppel
- Department of Trauma and Acute Care Surgery, University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA.
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Vamos CA, Foti TR, Reyes Martinez E, Pointer Z, Detman LA, Sappenfield WM. Identification of Clinician Training Techniques as an Implementation Strategy to Improve Maternal Health: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6003. [PMID: 37297607 PMCID: PMC10252379 DOI: 10.3390/ijerph20116003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
Training is a key implementation strategy used in healthcare settings. This study aimed to identify a range of clinician training techniques that facilitate guideline implementation, promote clinician behavior change, optimize clinical outcomes, and address implicit biases to promote high-quality maternal and child health (MCH) care. A scoping review was conducted within PubMed, CINAHL, PsycInfo, and Cochrane databases using iterative searches related to (provider OR clinician) AND (education OR training). A total of 152 articles met the inclusion/exclusion criteria. The training involved multiple clinician types (e.g., physicians, nurses) and was predominantly implemented in hospitals (63%). Topics focused on maternal/fetal morbidity/mortality (26%), teamwork and communication (14%), and screening, assessment, and testing (12%). Common techniques included didactic (65%), simulation (39%), hands-on (e.g., scenario, role play) (28%), and discussion (27%). Under half (42%) of the reported training was based on guidelines or evidence-based practices. A minority of articles reported evaluating change in clinician knowledge (39%), confidence (37%), or clinical outcomes (31%). A secondary review identified 22 articles related to implicit bias training, which used other reflective approaches (e.g., implicit bias tests, role play, and patient observations). Although many training techniques were identified, future research is needed to ascertain the most effective training techniques, ultimately improving patient-centered care and outcomes.
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Affiliation(s)
- Cheryl A. Vamos
- USF’s Center of Excellence in Maternal and Child Health Education, Science & Practice, The Chiles Center, College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Tara R. Foti
- College of Public Health, University of South Florida, Tampa, FL 33612, USA; (T.R.F.); (Z.P.)
| | - Estefanny Reyes Martinez
- College of Public Health, Florida Perinatal Quality Collaborative, University of South Florida, Tampa, FL 33612, USA;
| | - Zoe Pointer
- College of Public Health, University of South Florida, Tampa, FL 33612, USA; (T.R.F.); (Z.P.)
| | - Linda A. Detman
- The Chiles Center, College of Public Health, Florida Perinatal Quality Collaborative, University of South Florida, Tampa, FL 33612, USA; (L.A.D.); (W.M.S.)
| | - William M. Sappenfield
- The Chiles Center, College of Public Health, Florida Perinatal Quality Collaborative, University of South Florida, Tampa, FL 33612, USA; (L.A.D.); (W.M.S.)
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Mrozik A, Sellier Y, Lemaitre D, Gaucher L. Evaluation of Midwives' Practises on Herpetic Infections during Pregnancy: A French Vignette-Based Study. Healthcare (Basel) 2023; 11:healthcare11030364. [PMID: 36766939 PMCID: PMC9914294 DOI: 10.3390/healthcare11030364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/21/2023] [Accepted: 01/25/2023] [Indexed: 02/01/2023] Open
Abstract
(1) Background: One out of two pregnant women has a history of herpes infection. Initial infections have a high risk of neonatal transmission. Our objective was to analyse the professional practises of midwives regarding the management of herpes infections during pregnancy in France; (2) Methods: A national survey conducted via an online self-questionnaire, including clinical vignettes for which the midwives proposed a diagnosis, a drug treatment, a mode of birth, and a prognosis. These responses were used to evaluate the conformity of the responses to the guidelines, as well as the influence of certain criteria, such as mode of practise and experience; (3) Results: Of 728 responses, only 26.1% of the midwives reported being aware of the 2017 clinical practise guidelines. The midwives proposed taking the appropriate actions in 56.1% of the responses in the case of a recurrence, and in 95.1% of the responses in the case of a primary infection. For the specific, high-risk case of a nonprimary initial infection at 38 weeks of gestation, reporting knowledge of the recommendations improved the compliance of the proposed care by 40% (p = 0.02). However, 33.8% of the midwives underestimated the neonatal risk at term after a primary initial infection, and 43% underestimated the risk after a primary initial infection at term; (4) Conclusions: The majority of reported practises were compliant despite a low level of knowledge of the guidelines. The dissemination of guidelines may be important to improve information and adherence to appropriate therapeutic practise.
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Affiliation(s)
- Adrian Mrozik
- Obstetric Department, Hospital Group Paris Saint Joseph, 75014 Paris, France
- French College of Midwives (Collège National des Sages-Femmes de France, CNSF), 75010 Paris, France
| | - Yann Sellier
- French College of Midwives (Collège National des Sages-Femmes de France, CNSF), 75010 Paris, France
- EA 7328, Fetal Medicine Department Necker Hospital France, AP-HP, 92150 Suresnes, France
- School of Maieutics of Foch, UVSQ, 78180 Montigny-le-Bretonneux, France
| | - Déborah Lemaitre
- French College of Midwives (Collège National des Sages-Femmes de France, CNSF), 75010 Paris, France
| | - Laurent Gaucher
- French College of Midwives (Collège National des Sages-Femmes de France, CNSF), 75010 Paris, France
- Public Health Unit, Hospices Civils de Lyon, 69500 Bron, France
- INSERM U1290, Research on Healthcare Performance (RESHAPE), Claude Bernard Lyon 1 University, 69008 Lyon, France
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1206 Geneva, Switzerland
- Correspondence:
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Mendez-Figueroa H, Bell CS, Wagner SM, Pedroza C, Gupta M, Mulder I, Lee K, Blackwell SC, Bartal MF, Chauhan SP. Postpartum hemorrhage drills or simulations and adverse outcomes: a systematic review and Bayesian meta-analysis. J Matern Fetal Neonatal Med 2022; 35:10416-10427. [PMID: 36220264 DOI: 10.1080/14767058.2022.2128659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To compare the rates of adverse outcomes with postpartum hemorrhage (PPH) before and after implementation of drills or simulation exercises. STUDY ELIGIBILITY CRITERIA We included all English studies that reported on rates of PPH and associated complications during the pre- and post-implementation of interventional exercises. STUDY APPRASIAL AND SYNTHESIS METHODS Two investigators independently reviewed the abstracts, and full articles for eligibility of all studies. Inconsistencies related to study evaluation or data extraction were resolved by a third author. The co-primary outcomes were the rate of PPH and of any transfusion; the secondary outcomes included admission to the intensive care unit (ICU), transfusion ≥ 4 units of packed red blood cells, hysterectomy, or maternal death. Study effects were combined by Bayesian meta-analysis and reported as risk ratios (RR) and 95% credible intervals (Cr). RESULTS We reviewed 142 full length articles. Of these, 18 publications, with 355,060 deliveries-150,562 (42%) deliveries during the pre-intervention and 204,498 (57.6%) deliveries in the post-interventional period-were included in the meta-analysis. Using the Newcastle-Ottawa Scale, only three studies were considered good quality, and none of them were done in the US. The rate of PPH prior to intervention was 5.06% and 5.46% afterwards (RR 1.09, 95% CI 0.87-1.36; probability of reduction in the diagnosis being 21%). The likelihood of transfusion decreased from 1.68% in the pre-intervention to 1.27% in the post-intervention period (RR 0.80, 95% Cr 0.57-1.09). The overall probability of reduction in transfusion was 93%, albeit it varied among studies done in non-US countries (96%) versus in the US (23%). Transfusion of 4 units or more of blood occurred in 0.44% of deliveries before intervention and 0.37% afterwards (RR of 0.85, 95% CI 0.50-1.52), with the overall probability of reduction being 72% (76% probability of reduction in studies from non-US countries and 49% reduction with reports from the US). Surgical interventions to manage PPH, which was not reported in any US studies, occurred in 0.14% before intervention and 0.28% afterwards (RR 1.29; 95% CI 0.56-3.06; probability of reduction 27%). Admission to the ICU occurred in 0.10% before intervention and 0.08% subsequently (RR 0.92, 95% CI 0.58-1.43), with the overall probability of reduction being 65% (81% in studies from non-US countries and 27% from the study done in the US). Maternal death occurred in 0.17% in the pre-intervention period and 0.09% during the post-intervention (RR 0.62, 95% CI 0.33-1.05; probability of reduction 93% in studies from non-US countries and 82% in one study from the US). CONCLUSIONS Interventions to reduce the sequelae of PPH are associated with decrease in adverse outcomes. The conclusion, however, ought not to be accepted reflexively for the US population. All of the studies on the topic done in the US are of poor quality and the associated probability of reduction in sequelae are consistently lower than those done in other countries. SYNOPSIS Since the putative benefits of PPH drills or simulation exercises are based on poor quality pre- and post-intervention trials, policies recommending them ought to be revisited.
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Affiliation(s)
- Hector Mendez-Figueroa
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Cynthia S Bell
- Department of Center for Clinical Research & Evidence-Based Medicine in the Department of Pediatrics, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Steve M Wagner
- Department of Obstetrics and Gynecology, Alpert Medical School, Brown University, Providence, RI, USA
| | - Claudia Pedroza
- Department of Center for Clinical Research & Evidence-Based Medicine in the Department of Pediatrics, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Megha Gupta
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Isabelle Mulder
- Department of Obstetrics and Gynecology, University of Texas Southwestern, Dallas, TX, USA
| | - Keya Lee
- The Texas Medical Center Library, Houston, TX, USA
| | - Sean C Blackwell
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Michal F Bartal
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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Polic A, Curry TL, Louis JM. The Impact of Obesity on the Management and Outcomes of Postpartum Hemorrhage. Am J Perinatol 2022; 39:652-657. [PMID: 33053594 DOI: 10.1055/s-0040-1718574] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The study aimed to evaluate the impact of obesity on the management and outcomes of postpartum hemorrhage. STUDY DESIGN We conducted a retrospective cohort study of women who delivered at a tertiary care center between February 1, 2013 and January 31, 2014 and experienced a postpartum hemorrhage. Charts were reviewed for clinical and sociodemographic data, and women were excluded if the medical record was incomplete. Hemorrhage-related severe morbidity indicators included blood transfusion, shock, renal failure, transfusion-related lung injury, cardiac arrest, and use of interventional radiology procedures. Obese (body mass index [BMI] ≥ 30 kg/m2) and nonobese women were compared. Data were analyzed using Chi-square, Student's t-test, Mann-Whitney U test, and linear regression where appropriate. The p-value <0.05 was significant. RESULTS Of 9,890 deliveries, 2.6% (n = 262) were complicated by hemorrhage. Obese women were more likely to deliver by cesarean section (55.5 vs. 39.8%, p = 0.016), undergo a cesarean after labor (31.1 vs. 12.2%, p = 0.001), and have a higher quantitative blood loss (1,313 vs. 1,056 mL, p = 0.003). Both groups were equally likely to receive carboprost, methylergonovine, and misoprostol, but obese women were more likely to receive any uterotonic agent (95.7 vs. 88.9%, p = 0.007) and be moved to the operating room (32.3 vs. 20.4, p = 0.04). There was no difference in the use of intrauterine pressure balloon tamponade, interventional radiology, or decision to proceed with hysterectomy. The two groups were similar in time to stabilization. There was no difference in the need for blood transfusion. Obese women required more units of blood transfused (2.2 ± 2 vs. 2 ± 5 units, p = 0.023), were more likely to have any hemorrhage-related severe morbidity (34.1 vs. 25%, p = 0.016), and more than one hemorrhage related morbidity (17.1 vs. 7.9, p = 0.02). After controlling for confounding variables, quantitative blood loss, and not BMI was predictive of the need for transfusion. CONCLUSION Despite similar management, obese women were more likely to have severe morbidity and need more units of blood transfused. KEY POINTS · Obese women were more likely to have a higher quantitative blood loss and require more units of blood transfused.. · Obese women were more likely to experience any hemorrhage-related severe morbidity.. · Although obese women were more likely to be moved to the operating room for intervention, the rates of intrauterine pressure balloon tamponade, interventional radiology or hysterectomy were the same for obese and non-obese women..
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Affiliation(s)
- Aleksandra Polic
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | - Tierra L Curry
- Department of Internal Medicine, Hospital Corporations of America/Citrus Memorial Hospital, Inverness, Florida
| | - Judette M Louis
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida
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Brogaard L, Glerup Lauridsen K, Løfgren B, Krogh K, Paltved C, Boie S, Hvidman L. The effects of obstetric emergency team training on patient outcome: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2021; 101:25-36. [PMID: 34622945 DOI: 10.1111/aogs.14263] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/19/2021] [Accepted: 08/27/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Little is known about the optimal simulation-based team training in obstetric emergencies. We aimed to review how simulation-based team training affects patient outcomes in obstetric emergencies. MATERIAL AND METHODS Search Strategy: MEDLINE, Embase, Cochrane Library, and Cochrane Central Register of Controlled Trials were searched up to and including May 15, 2021. SELECTION CRITERIA randomized controlled trials (RCTs) and cohort studies on obstetric teams in high-resource settings comparing the effect of simulation-based obstetric emergency team training with no training on the risk of Apgar scores less than 7 at 5 min, neonatal hypoxic ischemic encephalopathy, severe postpartum hemorrhage, blood transfusion of four or more units, and delay of emergency cesarean section by more than 30 min. DATA COLLECTION AND ANALYSIS The included studies were assessed using PRISMA, EPCO, and GRADE. RESULTS We found 21 studies, four RCTs and 17 cohort studies, evaluating patient outcomes after obstetric team training compared with no training. Annual obstetric emergency team training may reduce brachial plexus injury (six cohort studies: odds ratio [OR] 0.47, 95% CI 0.33-0.68; one RCT: OR 1.30, 95 CI% 0.39-4.33, low certainty evidence) and suggest a positive effect; but it was not significant on Apgar score below 7 at 5 min (three cohort studies: OR 0.77, 95% CI 0.51-1.19; two RCT: OR 0.87, 95% CI 0.72-1.05, moderate certainty evidence). The effect was unclear for hypoxic ischemic encephalopathy, umbilical prolapse, decision to birth interval in emergency cesarean section, and for severe postpartum hemorrhage. Studies with in situ multi-professional simulation-based training demonstrated the best effect. CONCLUSIONS Emerging evidence suggests an effect of obstetric team training on obstetric outcomes, but conflicting results call for controlled trials targeted to identify the optimal methodology for effective team training.
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Affiliation(s)
- Lise Brogaard
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kasper Glerup Lauridsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Medicine, Randers Regional Hospital, Randers, Denmark
| | - Bo Løfgren
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Medicine, Randers Regional Hospital, Randers, Denmark
| | - Kristian Krogh
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Paltved
- Department of Human Resources, Medical simulation in Central Denmark Region (MidtSim), Aarhus, Denmark
| | - Sidsel Boie
- Department of Obstetrics and Gynecology, Randers Regional Hospital, Randers, Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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A Swedish register-based study exploring primary postpartum hemorrhage in 405 936 full term vaginal births between 2005 and 2015. Eur J Obstet Gynecol Reprod Biol 2021; 258:184-188. [PMID: 33450708 DOI: 10.1016/j.ejogrb.2020.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/25/2020] [Accepted: 12/06/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To explore diagnoses of postpartum haemorrhage following vaginal birth, in relation to socio-demographic and obstetrical data from women who gave birth at term, in Sweden, during the years 2005-2015. STUDY DESIGN A register-based cohort study was carried out, describing and comparing socio-demographic variables, obstetric variables and infant variables in 52 367 cases of diagnosed postpartum haemorrhage compared to 353 569 controls without a postpartum haemorrhage diagnosis. Postpartum hemorrhage was identified in The Swedish Medical Birth Register by ICD-10 code O72. Variables for maternal characteristics were dichotomized and used to calculate odds ratios to find possible explanatory variables for postpartum haemorrhage. RESULTS Between 2005 and 2015 there was no statistically significant decrease in diagnoses of postpartum haemorrhage after vaginal birth at term. Primiparity was associated with the highest risk and women birthing their fifth or subsequent child were associated with the lowest risk of postpartum hemorrhage. Increased maternal age (> 35 years) and/or obesity (BMI > 30) were associated with higher odds of postpartum haemorrhage. The risk of postpartum hemorrhage was 55 % higher when vaginal birth followed induction as compared to vaginal birth after spontaneous onset. Some of the factors known to be associated with postpartum haemorrhage were poorly documented in The Swedish Medical Birth Register. CONCLUSIONS Birthing women in a Swedish contemporary setting are, despite efforts to improve care, still at risk of birth being complicated by postpartum haemorrhage. Primiparity, increasing maternal age and/or obesity are found to provoke an increased risk and the reasons for these findings need to be further investigated. However, grand multi-parity did not increase the risk for postpartum hemorrhage. Codes for diagnoses require correct documentation in the birth records: only when local statistics are sound and correctly reported can intrapartum care be improved, and the incidence of postpartum haemorrhage reduced.
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Hotton EJ, Merialdi M, Crofts JF. Simulation for intrapartum care: from training to novel device innovation. Minerva Obstet Gynecol 2020; 73:82-93. [PMID: 33196635 DOI: 10.23736/s2724-606x.20.04669-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Improving maternal and perinatal care is a global priority. Simulation training and novel applications of simulation for intrapartum care may help to reduce preventable deaths worldwide. Evaluation studies have published details of the effectiveness of simulation training for obstetric emergencies, exploring clinical and non-clinical factors as well as the impact on patient outcomes (both maternal and neonatal). This review summarized the many uses of simulation in obstetric emergencies from training to assessment. It also described the adaption of training in low-resource settings and the evidence behind the equipment recommended to support simulation training. The review also discussed novel applications for simulation such as its use in the development of a new device for assisted vaginal birth and its potential role in Cesarean section training. This study analyzed the financial implications of simulation training and how this may impact the delivery of such training packages, considering that simulation should be developed and utilized as a key tool in the development of safe intrapartum care in both emergency and non-emergency settings, in innovation and product development.
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Affiliation(s)
- Emily J Hotton
- Department of Women and Children's Research, Southmead Hospital, Translational Health Sciences, University of Bristol, Bristol, UK -
| | | | - Joanna F Crofts
- Department of Women and Children's Research, Southmead Hospital, Translational Health Sciences, University of Bristol, Bristol, UK
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Hildebrand E, Nelson M, Blomberg M. Long-term effects of the nine-item list intervention on obstetric and neonatal outcomes in Robson group 1 - A time series study. Acta Obstet Gynecol Scand 2020; 100:154-161. [PMID: 32767668 PMCID: PMC7754388 DOI: 10.1111/aogs.13970] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/24/2020] [Accepted: 07/25/2020] [Indexed: 01/25/2023]
Abstract
Introduction The nine‐item list, with organizational and cultural changes, was implemented at the delivery unit in Linköping, Sweden between 2007 and 2010, aiming at improving the quality of care by offering more women a safe and attractive vaginal delivery. The target group for the intervention was nulliparous women at term with spontaneous onset of labor and cephalic presentation (Robson group 1). The aim of this study was to evaluate pregnancy outcomes before, during, early post and late post introduction of the nine‐item list. Material and methods Robson group 1 births (n = 12 763) from 2004 to 2018 were divided into four time periods; before the nine‐item list (2004‐2006), during introduction of the nine‐item list (2007‐2010), early post introduction of the nine‐item list (2011‐2014) and late post introduction of the nine‐item list (2015‐2018). The nine‐item list consists of monitoring of obstetric results, midwife coordinator, risk classification of women, three midwife‐competence levels, teamwork—the midwife, obstetrician and nurse working as a team with the common goal of a normal delivery, obstetric morning round, fetal monitoring skills and obstetric skills training. Perinatal outcomes before, during, early post and late post introduction were compared using a Student's t test for numerical variables and a Pearson chi‐squared test for categorical variables. Results Apgar score <7 at 5 minutes, Apgar score <4 at 5 minutes and umbilical cord arterial pH <7 did not differ significantly between the four time periods. Between before introduction and early post introduction, instrumental vaginal delivery decreased from 19.8% to 12.2% and cesarean section from 9.6% to 4.5%. The late post introduction period showed a maintained effect with 10.7% instrumental deliveries and 3.9% cesarean sections. Obstetric anal sphincter injury grade III decreased instantly during the introduction of the nine‐item list from 7.8% to 5.1% and thereafter remained unchanged. Conclusions Implementation of the nine‐item list increased the proportion of spontaneous vaginal deliveries by reducing the number of instrumental deliveries and cesarean sections without affecting the neonatal outcomes in nulliparous women with spontaneous onset of labor. The nine‐item list intervention seems to provide long‐term sustainable results.
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Affiliation(s)
- Eric Hildebrand
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Marie Nelson
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Marie Blomberg
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Muzeya F, Julie H. Student midwives' knowledge, skills and competency in relation to the active management of the third stage of labour: A correlational study. Curationis 2020; 43:e1-e8. [PMID: 32633991 PMCID: PMC7343921 DOI: 10.4102/curationis.v43i1.2054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 11/25/2022] Open
Abstract
Background Lesotho has been experiencing health challenges as indicated by its high maternal mortality ratio of 620 per 100 000 live births for the year 2010, which has been linked to its limited human resources. Objectives The knowledge and skills of final-year student nurse-midwives related to the active management of the third stage of labour were determined. Method A quantitative, descriptive survey design was used to conduct this study with 99 final-year midwifery students at four nursing schools in Lesotho using stratified sampling. The structured questionnaire collected data on the knowledge and self-reported competency. Subsequently, the controlled cord traction marks, extracted from the objective structured clinical examination (OSCE), were compared to the self-reported competency of these midwifery students using R software version 3.4.0. Results The mean score for knowledge and the OSCE was 73.8% (n = 99) and 77.2% (n = 99), respectively. The majority of respondents (95.2%, n = 99) rated themselves highly in terms of the active management of the third stage of labour competency. There was no correlation between the self-reported competency and knowledge (r = 0.08, p = 0.4402), and self-reported competency and OSCE scores (r = −0.004, p = 0.01). Conclusion The high mean scores for the knowledge and the OSCE indicate that the theoretical component of the curriculum on the active management of the third stage of labour was effective in equipping final-year midwifery students with knowledge and skills to carry out this competency.
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Affiliation(s)
- Fungai Muzeya
- Department of Nursing, Faculty of Community Health Sciences, University of the Western Cape, Cape Town.
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Bell SF, Watkins A, John M, Macgillivray E, Kitchen TL, James D, Scarr C, Bailey CM, Kelly KP, James K, Stevens JL, Edey T, Collis RE, Collins PW. Incidence of postpartum haemorrhage defined by quantitative blood loss measurement: a national cohort. BMC Pregnancy Childbirth 2020; 20:271. [PMID: 32375687 PMCID: PMC7201938 DOI: 10.1186/s12884-020-02971-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Visual estimation of blood loss following delivery often under-reports actual bleed volume. To improve accuracy, quantitative blood loss measurement was introduced for all births in the 12 hospitals providing maternity care in Wales. This intervention was incorporated into a quality improvement programme (Obstetric Bleeding Strategy for Wales, OBS Cymru). We report the incidence of postpartum haemorrhage in Wales over a 1-year period using quantitative measurement. METHODS This prospective, consecutive cohort included all 31,341 women giving birth in Wales in 2017. Standardised training was cascaded to maternity staff in all 12 hospitals in Wales. The training comprised mock-scenarios, a video and team drills. Uptake of quantitative blood loss measurement was audited at each centre. Data on postpartum haemorrhage of > 1000 mL were collected and analysed according to mode of delivery. Data on blood loss for all maternities was from the NHS Wales Informatics Service. RESULTS Biannual audit data demonstrated an increase in quantitative measurement from 52.1 to 87.8% (P < 0.001). The incidence (95% confidence intervals, CI) of postpartum haemorrhage of > 1000 mL, > 1500 mL and > 2000 mL was 8.6% (8.3 to 8.9), 3.3% (3.1 to 3.5) and 1.3% (1.2 to 1.4), respectively compared to 5%, 2% and 0.8% in the year before OBS Cymru. The incidence (95% CI) of bleeds of > 1000 mL was similar across the 12 hospitals despite widely varied size, staffing levels and case mix, median (25th to 75th centile) 8.6% (7.8-9.6). The incidence of PPH varied with mode of delivery and was mean (95% CI) 4.9% (4.6-5.2) for unassisted vaginal deliveries, 18.4 (17.1-19.8) for instrumental vaginal deliveries, 8.5 (7.7-9.4) for elective caesarean section and 19.8 (18.6-21.0) for non-elective caesarean sections. CONCLUSIONS Quantitative measurement of blood loss is feasible in all hospitals providing maternity care and is associated with detection of higher rates of postpartum haemorrhage. These results have implications for the definition of abnormal blood loss after childbirth and for management and research of postpartum haemorrhage.
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Affiliation(s)
- Sarah F Bell
- Department of Anaesthetics, Intensive Care and Pain Medicine, Cardiff and Vale University Health Board, Cardiff, UK
| | - Adam Watkins
- 1000 Lives Improvement, Public Health Wales, Tyndall Street, Cardiff, UK
| | - Miriam John
- Department of Emergency Medicine, Aneurin Bevan University Health Board, Newport, UK
| | | | - Thomas L Kitchen
- Department of Anaesthetics, Intensive Care and Pain Medicine, Cardiff and Vale University Health Board, Cardiff, UK
| | - Donna James
- Department of Obstetrics and Gynaecology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Cerys Scarr
- Department of Obstetrics and Gynaecology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Christopher M Bailey
- Department of Anaesthetics, Intensive Care and Pain Medicine, Betsi Cadwaladr University Health Board, Ysbyty Gwynedd, Bangor, UK
| | - Kevin P Kelly
- Department of Anaesthetics, Intensive Care and Pain Medicine, Betsi Cadwaladr University Health Board, Glan Clwyd Hospital, Bodelwyddan, UK
| | - Kathryn James
- Department of Anaesthetics, Intensive Care and Pain Medicine, Cardiff and Vale University Health Board, Cardiff, UK
| | - Jenna L Stevens
- Department of Anaesthetics, Aneurin Bevan University Health Board, Newport, UK
| | - Tracey Edey
- Department of Obstetrics and Gynaecology, Abertawe Bro Morgannwg University Health Board, Swansea, UK
| | - Rachel E Collis
- Department of Anaesthetics, Intensive Care and Pain Medicine, Cardiff and Vale University Health Board, Cardiff, UK
| | - Peter W Collins
- Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK. .,Departmentt of Haematology, University Hospital of Wales Heath Park, Cardiff, UK.
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Implementation of the D-A-CH postpartum haemorrhage algorithm after severe postpartum bleeding accelerates clinical management: A retrospective case series. Eur J Obstet Gynecol Reprod Biol 2020; 247:225-231. [PMID: 31980289 DOI: 10.1016/j.ejogrb.2020.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/23/2019] [Accepted: 01/01/2020] [Indexed: 11/22/2022]
Abstract
Implementation of the D-A-CH postpartum haemorrhage algorithm after severe postpartum bleeding accelerates clinical management: a retrospective observational case series. Jean-Jacques Ries, Lena Jeker, Michelle Neuhaus, Deborah R. Vogt, Thierry Girard, Irene Hoesli. OBJECTIVE Postpartum haemorrhage (PPH) is a leading cause of maternal death and severe morbidity. The algorithm for the three German speaking countries ("D-A-CH Handlungsalgorithmus Postpartale Blutung") for the management of PPH was introduced in 2012 at the University Hospital Basel. The aim of this study was to compare the blood loss, the initiation and application of the clinical management of severe PPH (≥1000 ml) after vaginal deliveries before and after the implementation of the algorithm. METHODS In this retrospective case series data were collected from a manual and an electronic database. The study was approved by the local ethical committee. Patients with an estimated blood loss of 1000 ml or more were included. The primary endpoint was the estimated total postpartum blood loss. Secondary endpoints were differences in pharmacological and surgical treatments, time from delivery to the initiation of a specific treatment and total costs. A propensity score analysis was performed to minimize potential bias between control and intervention group. RESULTS A total of 317 women were included, 141 women before (control group) and 176 women after the implementation of the algorithm (intervention group). Total postpartum blood loss did not differ between the groups (Median [IQR]: control group 1600 [1400, 2100] ml, intervention group 1500 [1400, 2000] ml). Use of sulprostone (OR 2.42 [1.52, 3.87], p = 0.004), tranexamic acid (OR 6.27 [3.65, 10.78], p < 0.001) and Bakri Balloon Tamponade® (BBT®) (OR 7.82 [2.68, 22.84], p = 0.004) and the application of rotational thromboelastoemtry (ROTEM®) (OR 32.37 [4.35, 240.56], p = 0.012) were significantly more frequent in the intervention group. In the intervention group tranexamic acid was administered significantly earlier (relative effect: 0.61 [0.50, 0.75], p < 0.001). No differences could be shown in haemoglobin concentration two days postpartum, transfer to the intensive care unit (ICU) or total costs of treatment. CONCLUSIONS The implementation of the D-A-CH algorithm in women after vaginal delivery with severe postpartum bleeding did not result in significantly reduced blood loss. However, it accelerated the clinical management and induced the application of a wider range of pharmacological interventions within a shorter interval after delivery without generating more costs.
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Non-clinical interventions to prevent postpartum haemorrhage and improve its management: A systematic review. Eur J Obstet Gynecol Reprod Biol 2019; 240:300-309. [DOI: 10.1016/j.ejogrb.2019.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 11/21/2022]
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