From the Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
Simul Healthc. 2024 Feb 1;19(1):21-26. doi: 10.1097/SIH.0000000000000702. Epub 2022 Nov 1.
Postpartum hemorrhage (PPH) remains a major cause of preventable maternal morbidity in the United States. Postpartum hemorrhage simulations were developed to improve provider recognition and treatment; however, there exist few studies that investigate their effects on individual outcomes. Our objective is to estimate the effect of a simulation-based educational intervention on PPH-related maternal morbidity outcomes.
We conducted a retrospective cohort analysis of hemorrhage outcomes at a single institution between March 2012 and January 2016 during the implementation of a high-fidelity PPH simulation. Women with PPH defined as an estimated blood loss greater than 500 mL for vaginal delivery and 1000 mL for cesarean delivery were included. The primary outcome was a composite of hemorrhage-related maternal morbidity (maternal death, hysterectomy, intensive care unit admission, blood transfusion, or unanticipated procedures to treat postpartum bleeding). Multivariable logistic regression adjusted for confounding variables between presimulation and postsimulation outcomes.
During the study period, 19,927 deliveries occurred with 4.5% of patients (888) experiencing hemorrhage. Women in the presimulation (n = 278) versus postsimulation groups (n = 610) had similar demographics. Although the PPH rate increased after simulation [2.8% pre vs. 6.1% post, odds ratio (OR), 2.25; 95% confidence interval (CI), 1.95-2.60], composite hemorrhage-related morbidity was lower after simulation training (44% pre vs. 35% post; OR, 0.70; 95% CI, 0.52-0.93). This reduction persisted after adjusting for confounding variables of mode of delivery and time from delivery to first uterotonic use (adjusted OR, 0.66; 95%, CI 0.49-0.89).
Despite an increased PPH rate, simulation education was associated with a reduction in a hemorrhage-related maternal composite morbidity.
产后出血（PPH）仍然是美国可预防产妇发病率的主要原因。已经开发出产后出血模拟来提高提供者的识别和治疗能力；然而，很少有研究调查它们对个别结果的影响。我们的目的是估计基于模拟的教育干预对与产后出血相关的产妇发病率结果的影响。
我们对 2012 年 3 月至 2016 年 1 月期间在一家机构实施高保真产后出血模拟期间的出血结果进行了回顾性队列分析。患有产后出血的女性被定义为阴道分娩出血量大于 500 毫升和剖宫产出血量大于 1000 毫升。主要结果是与出血相关的产妇发病率（产妇死亡、子宫切除术、重症监护病房入院、输血或意外治疗产后出血的程序）的复合结果。多变量逻辑回归调整了模拟前后结果之间的混杂变量。
在研究期间，有 19927 名产妇分娩，其中 4.5%（888 名）的患者发生出血。模拟前组（n = 278）和模拟后组（n = 610）的患者具有相似的人口统计学特征。尽管模拟后 PPH 发生率增加[2.8%前 vs. 6.1%后，比值比（OR）2.25；95%置信区间（CI）1.95-2.60]，但模拟培训后复合性出血相关发病率较低（44%前 vs. 35%后；OR，0.70；95%CI，0.52-0.93）。在调整分娩方式和从分娩到首次子宫收缩使用时间的混杂变量后，这种减少仍然存在（调整后的 OR，0.66；95%CI，0.49-0.89）。
尽管 PPH 发生率增加，但模拟教育与降低与出血相关的产妇复合发病率相关。
