Lebrun-Grandié V, Mattuizzi A, Martin A, Chabanier P, Merlot B, Elleboode B, Longaygues E, Saillour F, Sentilhes L
Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
Gynecol Obstet Fertil Senol. 2019 May;47(5):465-470. doi: 10.1016/j.gofs.2019.03.005. Epub 2019 Mar 11.
The aim of the study was to assess the impact of the introduction of training workshops on the quality of prevention and management of Post-Partum Hemorrhage (PPH) in a type III university center.
A clinical audit was carried out in our type III university center before and after the introduction of training workshops on the prevention and management of PPH, in two periods between January 1st to December 31st 2011 and March 1st and August 1st, 2015. Training workshops were according to the recommendations for clinical practice of the National College of Gynecologists-Obstetricians French published in 2014, and included a theoretical portion and a simulation of low fidelity manikin. Data on the management of patients presenting with PPH after vaginal birth of a singleton were retrospectively collected consecutively from medical records. Data were collected using a standardized analytical grid. Between the two data collections, some improvement actions were implemented.
After implementation of training workshops, the proportion of patients with active management of the third stage of labor (prophylactic uterotonic after delivery) has significantly improved (72% before, vs. 92% after, P=0.001); time to PPH diagnosis has been significantly higher notified (40% before, vs. 94% after, P<0.001), as well as the quantification of bleeding at diagnosis (46% before, vs. 72% after, P<0.003) and total bleeding (68% before, vs. 92%, P<0.001). PPH-specific monitoring sheet was found to be used significantly more frequently (3 before, vs. 30 after, P=0.00015). Additionally, the Physician Anesthesiologist has been contacted significantly more often (34% before, vs. 53% after, P=0.002).
Our study highlights a significant improvement in professional practices between 2011 and 2015 on PPH prevention and management in our type III university center.
本研究旨在评估在一所三级大学中心引入培训工作坊对产后出血（PPH）预防和管理质量的影响。
在2011年1月1日至12月31日以及2015年3月1日至8月1日这两个时间段内，于我们的三级大学中心引入PPH预防和管理培训工作坊前后分别进行了一次临床审计。培训工作坊依据2014年法国国家妇产科医师学院发布的临床实践建议开展，包括理论部分和低仿真人体模型模拟。从病历中连续回顾性收集单胎阴道分娩后出现PPH患者的管理数据。使用标准化分析表格收集数据。在两次数据收集之间，实施了一些改进措施。
培训工作坊实施后，第三产程积极管理（分娩后预防性使用宫缩剂）的患者比例显著提高（之前为72%，之后为92%，P = 0.001）；PPH诊断时间显著提前（之前为40%，之后为94%，P < 0.001），诊断时出血的量化（之前为46%，之后为72%，P < 0.003）以及总出血量（之前为68%，之后为92%，P < 0.001）也显著改善。发现PPH专用监测表的使用频率显著增加（之前为3次，之后为30次，P = 0.00015）。此外，与麻醉医师联系的频率也显著增加（之前为34%，之后为53%，P = 0.002）。
我们的研究突出了2011年至2015年间我们三级大学中心在PPH预防和管理方面专业实践的显著改善。
