背景:急诊产科护理培训,利用劳工和风险管理进展(ALARM)国际计划(AIP)在乌克兰实施,一个普遍获得熟练围产期和产科护理但资源有限的国家。来自28个产妇诊所的577个提供者(占总数的65.5%)参加了为期5天的培训课程,重点是产妇死亡的5个主要原因,通过实践技能研讨会,前测和后测,和客观的结构化临床检查。这种紧急产科护理培训对产妇结局的影响是本文的主题。
方法:进行非随机对照试验。实施培训的试点地区包括64个产科诊所,其中28个被视为病例,36个非参与诊所被视为对象。在培训之前,收集了2年(2004-2005年)的产妇结局数据,它发生在2006-2007年,并在实施培训后再次进行,从2008年到2009年。从189,852次交付中收集了信息。该研究的结果是手术分娩和产后出血的发生率。非参数统计,荟萃分析,和差异差异(DID)估计用于评估AIP对母体指数的影响。
结果:DID分析表明,训练结束后,与引用对象相比,输血量显著减少(OR:0.56;95CI:0.48-0.65),血浆输注(OR:0.70;95CI:0.63-0.78),和子宫探查(OR:0.64;95CI:0.59-0.69)。我们观察到产后出血≥1000ml无明显减少(OR:0.92;95CI:0.81-1.04;P=0.103)。阴道分娩的真空抽取率增加(OR:2.86;95CI:1.80-4.57),以及产钳辅助分娩(OR:1.80;95CI:1.00-3.25)和剖宫产(OR:1.11;95CI:1.06-1.17)。产后子宫切除术的发生和产妇死亡率没有变化。
结论:在普遍获得围产期和产科护理但资源有限的环境中,对产科工作人员进行了为期一周的急诊产科护理培训后,观察到与产后出血减少相关的干预措施.对使用真空提取和剖宫产的影响很小。
背景:从2012年7月12日回顾性注册071212007807。
BACKGROUND: Emergency obstetric care training, using Advances in Labour and Risk Management (ALARM) International Program (AIP) was implemented in Ukraine, a country with universal access to skilled perinatal and obstetric care but restricted resources. A total of 577 providers (65.5% of total) from 28 maternal clinics attended a 5-day training session focused on the five main causes of maternal mortality, with hands-on skill workshops, pre- and post- tests, and an objective structured clinical examination. The effects of this emergency obstetric care training on maternal outcomes is the subject of this paper.
METHODS: A non-randomized controlled
trial was conducted. The pilot areas where the training was implemented consisted of 64 maternity clinics of which 28 were considered as cases and 36 non-participating clinics were the referents. Data on maternal outcomes were collected for a 2-year span (2004-2005) prior to the trainings, which took place 2006-2007 and again after implementation of the trainings, from 2008 to 2009. Information was collected from 189,852 deliveries. Outcomes for the
study were incidences of operative delivery and postpartum hemorrhage. Non-parametric statistics, meta-analyses, and difference in difference (DID) estimation were used to assess the effect of the AIP on maternal indices.
RESULTS: DID analysis showed that after the training, compared to the referents, the cases had significant reduction of blood transfusions (OR: 0.56; 95%CI: 0.48-0.65), plasma transfusions (OR: 0.70; 95%CI: 0.63-0.78), and uterus explorations (OR: 0.64; 95%CI: 0.59-0.69). We observed a non-significant reduction of postpartum hemorrhage ≥1000 ml (OR: 0.92; 95%CI: 0.81-1.04; P = 0.103). Utilization of vacuum extraction for vaginal delivery increased (OR: 2.86; 95%CI: 1.80-4.57), as well as forceps assisted delivery (OR: 1.80; 95%CI: 1.00-3.25) and cesarean section (OR: 1.11; 95%CI: 1.06-1.17). There was no change in the occurrence of postpartum hysterectomy and maternal mortality.
CONCLUSIONS: After one week of Emergency Obstetrics Care training of the obstetric staff in a setting with universal access to perinatal and obstetric care but restricted resources, an association with the reduction of postpartum hemorrhage related interventions was observed. The effects on the use of vacuum extraction and cesarean section were minimal.
BACKGROUND: Retrospectively registered 071212007807 from 07/12/2012.