Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
J Matern Fetal Neonatal Med. 2021 Nov;34(21):3503-3509. doi: 10.1080/14767058.2019.1685974. Epub 2019 Nov 19.
To actively address maternal morbidity and mortality in Mexico, proficiency among obstetrics and gynecology (OBGYN) residents in the surgical management of postpartum hemorrhage (PPH) is a priority. However, the capacity of programs to provide this training is unknown.
The self-reported knowledge, education, and proficiency of common surgical techniques for the management of PPH among OBGYN residents in Mexico was evaluated. Educational resources, perceived barriers to acquiring skills, and clinical decision-making were explored.
In July of 2018, an anonymous electronic survey was sent to 86 residents at four hospitals throughout Mexico. Surgical techniques queried included uterine tamponade (UT), uterine compression sutures (UCS), uterine devascularization (UD), hypogastric artery ligation (HAL), and gravid hysterectomy (HT). Participants also answered case-based questions about a patient with PPH.
The survey response rate was 59.3% (51/86). Seventy-nine percent of residents reported understanding the rationale and techniques for the surgical intervention of PPH. However, 43.9% reported limited ability to perform these procedures with autonomy. Eighty-six percent of residents reported exposure to these techniques while performing a rescue procedure during PPH and 49% reported learning these procedures while performing prophylactic techniques in patients without PPH. Only 25.5% had been exposed to simulation training. Lack of a training module for these skills in their curriculum was noted by 74.5%. The majority of the participants chose UCS, UD, HAL, and HT as the first, second, third, and fourth rescue procedures to perform for PPH, respectively.
Most residents reported theoretical knowledge of surgical interventions for PPH, but their self-rated ability to independently perform such skills and a curriculum focused on PPH management was suboptimal.
为了积极应对墨西哥的孕产妇发病率和死亡率，妇产科住院医师在产后出血（PPH）的外科处理方面的熟练程度是当务之急。然而，目前尚不清楚各项目提供这种培训的能力。
评估墨西哥妇产科住院医师在处理产后出血的常见外科技术方面的自我报告知识、教育和熟练程度。探讨了教育资源、获得技能的感知障碍以及临床决策。
2018 年 7 月，向墨西哥四家医院的 86 名住院医师发送了一份匿名电子调查。询问的外科技术包括子宫填塞（UT）、子宫压迫缝合术（UCS）、子宫血管化（UD）、下腹动脉结扎术（HAL）和妊娠子宫切除术（HT）。参与者还回答了关于一名患有 PPH 患者的案例问题。
调查的回复率为 59.3%（51/86）。79%的住院医师报告说理解了 PPH 外科干预的原理和技术。然而，43.9%的人报告说，他们自主进行这些手术的能力有限。86%的住院医师报告说在进行 PPH 抢救手术时接触过这些技术，49%的人报告说在对没有 PPH 的患者进行预防性技术时学习了这些技术。只有 25.5%的人接触过模拟训练。74.5%的人注意到他们的课程中没有这些技能的培训模块。大多数参与者选择 UCS、UD、HAL 和 HT 作为治疗 PPH 的第一、第二、第三和第四种抢救手术。
大多数住院医师报告说他们对 PPH 的外科干预有理论知识，但他们自我评估独立执行这些技能的能力以及侧重于 PPH 管理的课程并不理想。
