Department of Health and Welfare/Ostfold Hospital Trust, Ostfold University College, Postal box code (PB) 700, NO-1757, Halden, Norway.
Ostfold Hospital Trust, Department of Anesthesia, 300 NO-1714, Grålum, PB, Norway.
BMC Emerg Med. 2021 Aug 28;21(1):98. doi: 10.1186/s12873-021-00490-8.
Postpartum hemorrhage (PPH) is a serious obstetric emergency, and one of the top five causes of maternal mortality globally. The most common causes of PPH include uterine atony, placental disorders, birth trauma and coagulation defects. Timely diagnosis and early management are critical to reduce morbidity, the need for blood transfusion or even mortality. External, manual aortic compression (AC) has been suggested as an intervention that reduce PPH and extend time for control of bleeding or resuscitation. This procedure is not commonly utilized by healthcare personnel. The incidence of home-births is increasing, and competence in PPH assessment and management is essential in prehospital personnel. The objective was to explore prehospital personnel's competence in PPH and AC, utilizing different tools.
The study was conducted in a county in South-eastern Norway, including five ambulance stations. All prehospital personnel (n = 250) were invited to participate in a questionnaire study. The questionnaire included the PPH self-efficacy (PPHSE) and PPH collective efficacy (PPHCE) tools, as well as tool developed utilizing the Delphi technique. Descriptive statistics were used to analyze the quantitative data, while quantitative content analysis was used to analyse free-text responses.
A total of 87 prehospital personnel responded to the questionnaire, 57.5% male, mean age 37.9 years. In total, 80.4% were ambulance workers and/or paramedics, and 96.6 and 97.7% respectively reported to need more education or training in PPH. Moreover, 82.8% reported having managed patient(s) with PPH, but only 2.9% had performed AC. Prehospital personnels' responses varied extensively regarding knowledge about what PPH is, how to estimate and handle PPH, and how to perform AC. Mean self-efficacy varied from 3.3 to 5.6, while collective efficacy varied from 1.9 to 3.8.
This study indicates that prehospital personnel lack knowledge about PPH and AC, due to various responses to the developed questionnaire. Even though AC is an acknowledged intervention in PPH, few participants reported that this was utilized. Our findings emphasize the need for education and training in PPH and PPH handling generally, and in AC specifically.
产后出血（PPH）是一种严重的产科急症，也是全球导致产妇死亡的五大原因之一。PPH 的最常见原因包括子宫收缩乏力、胎盘异常、分娩创伤和凝血缺陷。及时诊断和早期管理对于降低发病率、减少输血需求甚至降低死亡率至关重要。外部手动主动脉压迫（AC）已被提议作为一种干预措施，可以减少 PPH 并延长止血或复苏的控制时间。然而，这种方法并未被医疗保健人员广泛应用。家庭分娩的发生率正在增加，因此，院前人员在 PPH 评估和管理方面的能力至关重要。本研究旨在利用不同工具探讨院前人员在 PPH 和 AC 方面的能力。
本研究在挪威东南部的一个县进行，包括五个救护站。邀请所有院前人员（n=250）参加问卷调查。问卷包括产后出血自我效能（PPHSE）和产后出血集体效能（PPHCE）工具，以及利用德尔菲技术开发的工具。使用描述性统计分析对定量数据进行分析，同时使用定量内容分析对自由文本回复进行分析。
共有 87 名院前人员对问卷做出了回应，其中 57.5%为男性，平均年龄为 37.9 岁。总共，80.4%是救护车工作人员和/或护理人员，分别有 96.6%和 97.7%的人表示需要更多关于 PPH 的教育或培训。此外，82.8%的人报告管理过患有 PPH 的患者，但只有 2.9%的人实施过 AC。院前人员对 PPH 的定义、如何估计和处理 PPH 以及如何实施 AC 的知识的反应差异很大。自我效能的平均值从 3.3 到 5.6 不等，而集体效能的平均值从 1.9 到 3.8 不等。
本研究表明，由于对开发的问卷的各种反应，院前人员缺乏关于 PPH 和 AC 的知识。尽管 AC 是 PPH 中公认的干预措施，但很少有参与者报告使用过该方法。我们的研究结果强调了普遍需要进行 PPH 和 PPH 处理以及具体的 AC 教育和培训。
