Postpartum Hemorrhage Prevention by Early Recognition, Knowledge, and Skilled Practices

2021-06-08 11:18:36
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Vanderbilt University
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Hancock, A., Weeks, A. D., & Lavender, D. T. (2015). Is accurate and reliable blood loss estimation the 'crucial step' in early detection of postpartum hemorrhage: an integrative review of the literature. BMC Pregnancy and Childbirth, 15:230.

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Hancock, Weeks, and Lavender (2015) conducted an integrative literature review of past research studies to ascertain the criticality of reliable and accurate estimation of blood loss in early identification of PPH. The authors concentrate on previous research to provide their extensive and integrative review hence exploring blood loss approximation methods and strategies applicable during childbirth. The hypothesis of the integrative review study follows experts suggestions that enhancing reliability and accuracy in estimating blood loss is one of the essential steps in averting PPH morbidity and death among women. The authors achieve their objectives through the exploration of all strategies applicable in estimating the amount of blood lost during maternal childbirth.

The study methodology is exploration investigation which entails an integrative and systematic reviewing of research literature from previously published studies. A total of 36 studies among them were 22 observational studies, four randomized trials, three audit reports, four qualitative studies without specific perspective, one grounded theory, one Husserlian phenomenology study, and one naturalistic inquiry. A cross-examination was conducted with a particular interest in approved methods of assessing blood loss, visual evaluation and their effects on PPH identification, analysis, and management.

The results indicated that the leading method for evaluating blood loss is visual estimation discovered in 9 studies followed by a mixture of spectrophotometry and visual estimation in 7 studies. The main finding is that visuals estimation as the common assessment methods is responsible for inaccuracy and subsequent complexities in PPH treatment and diagnosis. Furthermore, Hancock, Weeks, and Lavender (2015) discovered that multifaceted interventions such as the use of blood collection bag and training can enhance blood loss estimation and evaluation but has little effect on clinical results and cannot prevent PPH delays.

The conclusion of the review is that enhancing reliability and accuracy of strategies for evaluating and estimating the volume of blood lost while giving birth do not improve PPH early diagnosis. PPH diagnosis and consequential maternal outcomes are reliant on factors such as nature and speed of blood loss and not entirely on volume. The authors recommend that future research studies should change in scope and direction to enhance detail exploration and provision of qualitative evidence.

Nelissen, E., Ersdal, H., Mduma, E., Evjen-Olsen, B., Broerse, J., Roosmalen, J. V., & Stekelenburg, J. (2015). Helping Mothers Survive Bleeding After Birth: retention of knowledge, skills, and confidence nine months after obstetric simulation-based training. BMC Pregnancy and Childbirth, 15:190.

Nelissen et al. (2015) conducted a research study in Northern Tanzania with the purpose of demonstrating the importance of confidence, skills, and knowledge on obstetric care for preventing after-birth bleeding among women. The researchers measured the levels of confidence, skills, and knowledge of the subjects passed through a simulation-based training. Measurements were conducted before and after the training. After the training, the interval of measurements is immediately and a follow-up assessment nine months after the completion of the simulation training. The importance of the study is to offer evidence-based guidance regarding how confidence, skills, and knowledge about obstetric care decay with times hence inducing the necessity to conduct follow-up training.

The adopted methodology is educational intervention research with the primary subjects being 89 employees from different healthcare units of a referral clinic in rural Tanzania. Professionals are passed through a training session to equip them with skills and knowledge for assisting mothers to survive after-birth bleeding. The training session ends with a test testing 38 workers selected randomly to challenge skills and knowledge acquisition after the training on areas such as PPH management and handling and managing 3rd stage labor cases. The skills testing session is achieved through two scenarios of simulated PPH management and basic delivery setups. The workers completed a multiple-choice questionnaire with 26 items to ascertain their knowledge on managing maternal labor and associated complexities such as PPH. Furthermore, there was the administration of 5-item questionnaire in written form which tested the subjects skills in assessing uterine compression, determining of placenta completeness and necessitation of advanced care. Tests are carried out before training, immediately after its completion and nine months later.

The results of the study showed that there was an increase in average knowledge scores among the participants by 7%, 70% (before training) to 77% (immediately after training), and reduced when pre-training session approaches to 72% with the p = 0.386 in comparison with pre-training knowledge scores. Skills for basic delivery rose to 51% from 43% before training, and nine months later, the average figure dropped to 49% (p = 0.165). On the other hand, average PPH management score increased to 51% from 39% before training and nine months later, the figure reduced to 50% (p = 0.003). The skills related to uterine compression scores increased to 43% from 19% and then significantly increased to 48% after nine months indicating a p-value of 0.000. After the training session, the participants increased levels of confidence as shown by the results of the follow-up testing after nine months. The article concludes that training leads to an immediate rise in levels of confidence, skills, and knowledge. Although the levels of knowledge and skills in basic delivery reduced after nine months, skills in obstetric emergency and general confidence in helping mothers to endure cases of bleeding after giving birth were retained. Research findings reveal that there is a growing necessity for continuance of training to increase retention of the skills and knowledge. Nelissen, et al. (2015) recommends that in future, related studies should include an emphasis on dosage and frequency of offering follow-up teaching.

Markova, V., Sorensen, J., Holm, C., Norgaard, A., & Langhoff-Roos, J. (2012). Evaluation of multi-professional obstetric skills training for postpartum hemorrhage. Acta Obstetricia et Gynecologica Scandinavica, 91(3):346-352.

Markova, Sorensen, Holm, Norgaard, and Langhoff-Roos (2012) conducted a study in Rigs Hospitalet Hospital in Copenhagen, Demark with the objective of training professionals on obstetric skills and later evaluating the subjects to ascertain the effect of the training reducing PPH incidences. The factors that indicate outcome measures include the rate at which professions respond to surgical intervention and RBC transfusion. The rate of RBC transfusion and time delay are evaluated before the training, while the training continues and after the end of the training session.

The research methodology entailed the analysis of the hospitals medical records and evaluating the transfusion database. The subjects were 148 women with cases of PPH RBC transfusion. A total of 10,461 deliveries were analyzed, and the data assessed during the research include transfusion data, surgical intervention and the causes of PPH.

The research findings show that the rates of RBC transfusion in 2007 (after training), 2005 (during training) and 2003 (before training) were 1.2%, 1.6%, and 1.5% respectively for PPH incidences. After cases of vaginal delivery, there were no changes in the rates of transfusion, but there was a significant decrement in cesarean units over the three years by 0.7%, 2.1% and 2.4% (p < 0.01). Furthermore, there were no changes in the values of pre-transfusion hemoglobin and transfusion requirements. Regarding total time from delivery to the removal of placenta using the manual procedure, there was a non-significant increment in median time ranging from 64 minutes in before training, 70 minutes during the training and 75 minutes after the training session. The median decision-making time across the entire process across the three research periods remained unchanged such that after, before and during the training, the professions used a median of 30 minutes.

Markova, Sorensen, Holm, Norgaard, and Langhoff-Roos (2012) conclude that the training to enhance obstetric skills did not produce positive results since there was a little effect RBC transfusion rate. Time delay similarly remained unchanged, and the article offers a recommendation of applying a multi-disciplinary training approach to enhance collaboration among the professions working in Operation Theater and anesthesiology units.

References

BIBLIOGRAPHY Hancock, A., Weeks, A. D., & Lavender, D. T. (2015). Is accurate and reliable blood loss estimation the 'crucial step' in early detection of postpartum hemorrhage: an integrative review of the literature. BMC Pregnancy and Childbirth, 15:230. doi:10.1186/s12884-015-0653-6

Markova, V., Sorensen, J., Holm, C., Norgaard, A., & Langhoff-Roos, J. (2012). Evaluation of multi-professional obstetric skills training for postpartum hemorrhage. Acta Obstetricia et Gynecologica Scandinavica, 91(3):346-352. doi:10.1111/j.1600-0412.2011.01344.x.

Nelissen, E., Ersdal, H., Mduma, E., Evjen-Olsen, B., Broerse, J., Roosmalen, J. V., & Stekelenburg, J. (2015). Helping Mothers Survive Bleeding After Birth: retention of knowledge, skills, and confidence nine months after obstetric simulation-based training. BMC Pregnancy and Childbirth, 15:190. doi:10.1186/s12884-015-0612-2

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