Division of Global Women's Health, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; the American College of Obstetricians and Gynecologists, Washington, DC; and Kamuzu Central Hospital, Lilongwe, Malawi.
Obstet Gynecol. 2019 Mar;133(3):507-514. doi: 10.1097/AOG.0000000000003108.
To evaluate maternal mortality and changes in the culture of safety before and after the implementation of the Alliance for Innovation on Maternal Health (AIM) Malawi program.
This was a prospective cohort study at a central hospital and a district health center in Malawi from March 2016 to November 2017. The AIM Malawi program included classroom didactics on obstetric hemorrhage, teamwork protocols, skills laboratory activities, and simulation training. The time periods of comparison were preintervention, education period, and postintervention. Hospital birth paper records were used to collect data on patient demographics and obstetric and neonatal information. The Hospital Survey of Patient Safety was used to measure the culture of safety before and after the program.
We trained 128 participants. In the postintervention period, 16 procedural interventions were performed to manage postpartum hemorrhage, including B-lynch sutures (n=7), condom balloon catheter (n=5), nonpneumatic antishock garment (n=3), and uterine artery ligation (n=1). There was a significant increase in the use of B-lynch sutures for the management of uterine atony in the postintervention compared with preintervention period (P=.014). In the postintervention period, the rate of maternal mortality from obstetric hemorrhage decreased significantly from 1.2% to 0.2% (P=.02), a relative decrease of 82.1% from the preintervention rate. Hospital safety culture scores improved significantly from baseline in four out of five domains after the AIM Malawi training.
After implementation of the AIM Malawi program, we found an increased use of postpartum hemorrhage procedural interventions, a decreased rate of maternal mortality and an increase in Hospital Survey of Patient Safety composite safety scores. The AIM Malawi program may be an effective framework for adaptation to improve maternal mortality in a low-resource setting.
评估在实施孕产妇健康创新联盟（AIM）马拉维项目前后产妇死亡率和安全文化的变化。
这是一项在马拉维一家中央医院和一家地区保健中心进行的前瞻性队列研究，时间为 2016 年 3 月至 2017 年 11 月。AIM 马拉维项目包括产科出血课堂教学、团队合作协议、技能实验室活动和模拟培训。比较时间段为干预前、教育期和干预后。医院分娩记录用于收集患者人口统计学以及产科和新生儿信息。使用医院患者安全调查来衡量项目前后的安全文化。
我们培训了 128 名参与者。在干预后期间，进行了 16 项产后出血处理的程序干预，包括 B-Lynch 缝合术（n=7）、避孕套球囊导管（n=5）、非充气式抗休克服（n=3）和子宫动脉结扎术（n=1）。与干预前相比，B-Lynch 缝合术在干预后用于治疗宫缩乏力的使用率显著增加（P=.014）。在干预后期间，产科出血导致的产妇死亡率从 1.2%显著下降至 0.2%（P=.02），与干预前相比相对下降了 82.1%。在 AIM 马拉维培训后，五个领域中的四个在基线的基础上医院安全文化评分显著提高。
在实施 AIM 马拉维项目后，我们发现产后出血程序干预的使用率增加，产妇死亡率下降，医院患者安全调查综合安全评分增加。AIM 马拉维项目可能是适应低资源环境以降低产妇死亡率的有效框架。
