Research Department, Haydom Lutheran Hospital, POB 9000, Haydom, Manyara, Tanzania.
Department of Obstetrics and Gynaecology, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK.
BMC Pregnancy Childbirth. 2017 Sep 11;17(1):301. doi: 10.1186/s12884-017-1481-7.
Postpartum haemorrhage (PPH) is a major cause of maternal mortality. Prevention and adequate treatment are therefore important. However, most births in low-resource settings are not attended by skilled providers, and knowledge and skills of healthcare workers that are available are low. Simulation-based training effectively improves knowledge and simulated skills, but the effectiveness of training on clinical behaviour and patient outcome is not yet fully understood. The aim of this study was to assess the effect of obstetric simulation-based training on the incidence of PPH and clinical performance of basic delivery skills and management of PPH.
A prospective educational intervention study was performed in a rural referral hospital in Tanzania. Sixteen research assistants observed all births with a gestational age of more than 28 weeks from May 2011 to June 2013. In March 2012 a half-day obstetric simulation-based training in management of PPH was introduced. Observations before and after training were compared. The main outcome measures were incidence of PPH (500-1000 ml and >1000 ml), use and timing of administration of uterotonic drugs, removal of placenta by controlled cord traction, uterine massage, examination of the placenta, management of PPH (>500 ml), and maternal and neonatal mortality at 24 h.
Three thousand six hundred twenty two births before and 5824 births after intervention were included. The incidence of PPH (500-1000 ml) significantly reduced from 2.1% to 1.3% after training (effect size Cohen's d = 0.07). The proportion of women that received oxytocin (87.8%), removal of placenta by controlled cord traction (96.5%), and uterine massage after birth (93.0%) significantly increased after training (to 91.7%, 98.8%, 99.0% respectively). The proportion of women who received oxytocin as part of management of PPH increased significantly (before training 43.0%, after training 61.2%). Other skills in management of PPH improved (uterine massage, examination of birth canal, bimanual uterine compression), but these were not statistically significant.
The introduction of obstetric simulation-based training was associated with a 38% reduction in incidence of PPH and improved clinical performance of basic delivery skills and management of PPH.
产后出血（PPH）是产妇死亡的主要原因。因此，预防和充分治疗非常重要。然而，在资源匮乏的环境中，大多数分娩都没有得到熟练提供者的照顾，而且现有的医疗保健工作者的知识和技能水平也很低。基于模拟的培训可有效提高知识和模拟技能，但培训对临床行为和患者结局的有效性尚不完全清楚。本研究旨在评估产科模拟培训对产后出血发生率以及基本分娩技能的临床表现和产后出血管理的影响。
在坦桑尼亚的一家农村转诊医院进行了前瞻性教育干预研究。从 2011 年 5 月至 2013 年 6 月，16 名研究助理观察了所有 28 周以上胎龄的分娩。2012 年 3 月，引入了为期半天的产后出血管理产科模拟培训。比较培训前后的观察结果。主要结局指标为产后出血发生率（500-1000ml 和>1000ml）、宫缩剂的使用和给药时间、控制性脐带牵引下胎盘取出、子宫按摩、胎盘检查、产后出血管理（>500ml）以及产妇和新生儿在 24 小时的死亡率。
干预前纳入了 3622 例分娩，干预后纳入了 5824 例分娩。培训后，产后出血（500-1000ml）的发生率从 2.1%降至 1.3%（效应大小 Cohen's d=0.07）。接受催产素（87.8%）、控制性脐带牵引下胎盘取出（96.5%）和产后子宫按摩（93.0%）的产妇比例在培训后显著增加（分别提高到 91.7%、98.8%和 99.0%）。接受催产素作为产后出血管理一部分的产妇比例显著增加（培训前 43.0%，培训后 61.2%）。产后出血管理的其他技能也有所改善（子宫按摩、检查产道、双手子宫压迫），但无统计学意义。
引入产科模拟培训与产后出血发生率降低 38%相关，并且提高了基本分娩技能和产后出血管理的临床表现。
