Department of Obstetrics and Gynaecology, Radboud University Nijmegen, Nijmegen, the Netherlands.
BMC Pregnancy Childbirth. 2010 Jan 26;10:5. doi: 10.1186/1471-2393-10-5.
One of the most important causes of maternal mortality and severe morbidity worldwide is post partum haemorrhage (PPH). Factors as substandard care are frequently reported in the international literature and there are similar reports in the Netherlands. The incidence of PPH in the Dutch population is 5% containing 10.000 women a year. The introduction of an evidence-based guideline on PPH by the Dutch society of Obstetrics and Gynaecology (NVOG) and the initiation of the MOET course (Managing Obstetrics Emergencies and Trauma) did not lead to a reduction of PPH. This implies the possibility of an incomplete implementation of both the NVOG guideline and MOET-instructions. Therefore, the aim of this study is to develop and test a tailored strategy to implement both the NVOG guideline and MOET-instructions
METHODS/DESIGN: One step in the development procedure is to evaluate the implementation of the guideline and MOET-instructions in the current care. Therefore measurement of the actual care will be performed in a representative sample of 20 hospitals. This will be done by prospective observation of the third stage of labour of 320 women with a high risk of PPH using quality indicators extracted from the NVOG guideline and MOET instructions. In the next step barriers and facilitators for guideline adherence will be analyzed by performance of semi structured interviews with 30 professionals and 10 patients, followed by a questionnaire study among all Dutch gynaecologists and midwives to quantify the barriers mentioned. Based on the outcomes, a tailored strategy to implement the NVOG guideline and MOET-instructions will be developed and tested in a feasibility study in 4 hospitals, including effect-, process- and cost evaluation.
This study will provide insight into current Dutch practice, in particular to what extent the PPH guidelines of the NVOG and the MOET-instructions have been implemented in the actual care, and into the barriers and facilitators regarding guideline adherence. The knowledge of the feasibility study regarding the effects and costs of the tailored strategy and the experiences of the users can be used in countries with a relatively high incidence of PPH.
ClinicTrials.gov NCT00928863.
全球孕产妇死亡和严重发病的最重要原因之一是产后出血（PPH）。国际文献中经常报道护理标准不达标等因素，荷兰也有类似的报告。荷兰人口中 PPH 的发病率为 5%，每年有 10000 名妇女。荷兰妇产科协会（NVOG）发布了 PPH 的循证指南，并启动了 MOET 课程（管理产科急症和创伤），但这并没有降低 PPH 的发病率。这意味着 NVOG 指南和 MOET 指令的执行可能并不完整。因此，本研究的目的是制定和测试一种针对 PPH 循证指南和 MOET 指令的实施策略。
方法/设计：开发过程中的一个步骤是评估当前护理中指南和 MOET 指令的实施情况。因此，将通过前瞻性观察高危 PPH 的 320 名妇女的第三产程，使用从 NVOG 指南和 MOET 指令中提取的质量指标，在 20 家代表性医院的样本中进行实际护理的测量。在下一步中，将通过对 30 名专业人员和 10 名患者进行半结构化访谈，分析遵循指南的障碍和促进因素，然后对所有荷兰妇科医生和助产士进行问卷调查，以量化提到的障碍。基于研究结果，将在 4 家医院进行可行性研究，制定并测试一种针对 NVOG 指南和 MOET 指令的实施策略，包括效果、过程和成本评估。
本研究将深入了解荷兰当前的实践情况，特别是 NVOG 的 PPH 指南和 MOET 指令在实际护理中的实施程度，以及关于遵循指南的障碍和促进因素。可行性研究中关于该策略效果和成本的知识以及使用者的经验可用于 PPH 发病率相对较高的国家。
ClinicTrials.gov NCT00928863。
