Training of maternal health care providers in newer modalities of management of post-partum haemorrhage
Keywords:Active management of third stage of labour, Bakri Balloon therapy, Emergency obstetric care, Maternal mortality, Non-pneumatic anti shock garment, Post-Partum haemorrhage
Background: Postpartum haemorrhage (PPH) is a life-threatening complication, that occurs suddenly and unexpectedly. Institutional delivery by skilled birth attendant who are trained in active management of third stage of labour and those who can use of Uterine Balloon Tamponade and Non-pneumatic anti shock garment can reduce incidence and morbidity related to PPH. The objective of the paper was to share the experiences of the training programmes held for maternal health care workers in the newer modalities of PPH management.
Methods: During one and a half year period, 32 Continuation of Medical Education (CME) programmes, with the theme of “Managing Obstetric Emergencies and Obstetric Trauma”, covering important topics related to high risk pregnancies like Hypertension, Eclampsia ,Anaemia and Haemorrhage at 32 health institutions, spread over 11 states and 2 union territories in India, were conducted .In addition,42 hands on workshops at various health facilities were conducted with training of more than 2575 maternal health care providers.
Results: The pre and post test scores revealed that 95 percent of the maternal health care providers were unaware about the use of Uterine Balloon Tamponade (Bakri balloon) in PPH and Non-pneumatic anti shock garment (NASG). Seventy percent were unaware about the proper sequence of steps of active management of third stage of labour. Training programmes helped to improve the knowledge, whereas hands on workshop, helped in skill development of the health care providers. The participants expressed great satisfaction regarding the knowledge and skills they acquired through training programme on management of post-partum haemorrhage. They gave positive feedback about the quality, contents and conduct of training programme.
Conclusions: There is need for refresher training of maternal health care providers in newer modalities like AMTSL, NASG and Bakri balloon, which have potential to save lives.
Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: A systematic review. Lancet 2006;367(9516):1066-74.
Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, et al. Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. The Lancet. 2010;375(9726):1609-23.
UNICEF. Information by Country - Statistics- Women's Health.
Beyond the Numbers: Reviewing Maternal Deaths and Complications to Make Preganancy Safer". Geneva: WHO; 2004.
World Health Organization Library. WHO Recommendations for the prevention and treatment of postpartum haemorrhage. Geneva, Switzerland: World Health Organization Library; 2012.
Amy JJ. Severe postpartum haemorrhage: A rational approach. Natl Med J India. 1998;11(2):86-8.
Rao KA. Presidential address. The 44th All India Obstetric and Gynecological congress. Ahmedabad.2000. J Obstet Gynecol India. 2001;51: 25-8.
AbouZahr C. Global burden of maternal death and disability. British Medical Bulletin. 2003;67(1):1-1.
American College of Obstetricians and Gynecologists. ACOG practice bulletin: Clinical management guidelines for obstetrician-gynecologists number 76, October 2006: postpartum hemorrhage. Obstet Gynecol 2006;108(4):1039-47.
Commission on Behavioral and Social Sciences and Education (CBASSE) (2000). The Consequences of Maternal Morbidity and Maternal Mortality: Report of a Workshop. Washington, D.C: The National Academies.
Turan J, Ojengbede O, Fathalla M, Mourad-Youssif M, Morhason-Bello IO, Nsima D, et al. Positive effects of the non-pneumatic anti-shock garment on delays in accessing care for postpartum and postabortion hemorrhage in Egypt and Nigeria. J Womens Health (Larchmt). 2011;20(1):91-8.
Non-pneumatic Anti-shock Garment-Compendium of New and Emerging Technologies that Address Global Health Concerns. Geneva: World Health Organization; 2011. Available from: http://www.who.int/medical_devices/innovation/new_emerging_tech_30.pdf.
Pileggi-Castro C, Nogueira-Pileggi V, Tunçalp Ö, Oladapo OT, Vogel JP, Souza JP. Non-pneumatic anti-shock garment for improving maternal survival following severe postpartum haemorrhage: A systematic review. Reprod Health 2015;12:28.
Maknikar S, Nanda R, Miller S. NASG reduces mortality in Indian women with PPH. Int J Gynecol Obstet 2012;119:S413.
Magwali T, Butrick E, Mambo V, Ayadi A, Lippman S, Bergel E. Non-pneumatic anti-shock garment (NASG) for obstetric hemorrhage: Haraze, zimbabwe. Int J Gynecol Obstet 2010;119:S410.
Bakri YN. Balloon device for control of obstetrical bleeding. Eur J Obstet Gynecol Reprod Biol. 1999;86(12):S84.
The Bakri Balloon Up to Date. Available at www.uptodate.com.
Balachandram V. Maternal Mortaltiy in Kaduna, Nigeria Med J.1995;5:366-70.
Bais JM, Eskes M, Pel M, Bonsel GJ, Bleker OP. Postpartum haemorrhage in nulliparous women: incidence and risk factors in low and high risk women: a Dutch population-based cohort study on standard (≥500 ml) and severe (≥ 1000 ml) postpartum haemorrhage. Europe J Obstet Gynecol Reproduct Biol. 2004;115(2):166-72.
Magann, EF, Evans S, Flutechnison M, Collins R, Lanneau G. and Mirrison JL. Postpartum heamorhage after cesarean delivery: an analysis of risk factors. S Med Jorn.2005:98(7):618 – 5.
Miller S, Ojengbede O, Turan JM, Morhason‐Bello IO, Martin HB, Nsima D. A comparative study of the non‐pneumatic anti‐shock garment for the treatment of obstetric hemorrhage in Nigeria. Int J Gynecol Obstet. 2009;107(2):121-5.
Miller S, Fathalla MM, Ojengbede OA, Camlin C, Mourad-Youssif M, Morhason-Bello IO et al. Obstetric hemorrhage and shock management: using the low technology Non-pneumatic Anti-Shock Garment in Nigerian and Egyptian tertiary care facilities. BMC pregnancy and childbirth. 2010;10(1):64.
Turan J, Ojengbede O, Fathalla M, Mourad-Youssif M, Morhason-Bello IO, Nsima D, Morris J, Butrick E, Martin H, Camlin C, Miller S. Positive effects of the non-pneumatic anti-shock garment on delays in accessing care for postpartum and postabortion hemorrhage in Egypt and Nigeria. J Women's Health. 2011;20(1):91-8.
Miller S, Bergel EF, El Ayadi AM, Gibbons L, Butrick EA, Magwali T, et al. Non-Pneumatic Anti-Shock Garment (NASG), a First-Aid Device to Decrease Maternal Mortality from Obstetric Hemorrhage: A Cluster Randomized Trial. Abdel-Aleem H, editor. PLoS One. 2013;8(10):e76477.
Pileggi-Castro C, Nogueira-Pileggi V, Tunçalp Ö, Oladapo OT, Vogel JP, Souza JP. Non-pneumatic anti-shock garment for improving maternal survival following severe postpartum haemorrhage: a systematic review. Reprod Health 2015;12(1):28.
El Ayadi AM, Butrick E, Geissler J, Miller S. Combined analysis of the non-pneumatic anti-shock garment on mortality from hypovolemic shock secondary to obstetric hemorrhage. BMC Pregnancy Childbirth 2013;13(1):208.
Lalonde André. Prevention and treatment of postpartum hemorrhage in low-resource settings. Int J Gynecol Obstet. 2012;117(2):108-18.
World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: World Health Organization; 2012. Available from: http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/9789241548502/en/. [cited 2015 Aug 23]
World Health Organization, UNICEF, United Nations Population Fund (UNFPA) Managing complications in pregnancy and childbirth: a guide for midwives and doctors. 2. Geneva: World Health Organization; 2017.
Karoshi M, Keith L, Arulkumaran S, Lalonde A. Postpartum hemorrhage: Guidelines for Immediate Action, Wall Chart. Global Library of Women’s Medicine. 2012.
JHPIEGO. Helping Mothers Survive Bleeding After Birth: Providers Guide: Jhpiego Corporation; 2015. p. 48. Available at https://www.jhpiego.org/wp-content/uploads/2016/03/Helping-Mothers-Survive-Bleeding-after-Birth_0.pdf
Survive and Thrive. Guiding the way forward: Survive and Thrive 5-year Report (2012-2017).2018. Available at https://surviveandthrive.org/about/Documents/Survive%20%20Trive%205%20year%20report%20FINAL.pdf.
Chhaya VA, Sharma JK, Ameel M, Sundararaman T. Healthcare Technology Assessment for Non-Pneumatic Anti Shock Garment for Obstetric Shock Prevention. Available at [http://www.who.int/medical_devices/global_forum/E02.pdf]
Satia JK, Jayantilal K, Misra M, Arora R, Neogi S. Innovations in maternal health : case studies from India. New Delhi: Sage Publications; 2014.
Mankikar S, Nanda R, Miller S. NASG reduces mortality in Indian women with PPH. Int J Gynecol Obstet. 2012;119(S3):S413.
Sloan Nancy L., Storey Andrew, Fasawe Olufunke, Yakubu Jamila, McCrystal Kelly, Wiwa Owens, Lothe Lene Jeanette, Grepstad Mari. Advancing Survival in Nigeria: A Pre-post Evaluation of an Integrated Maternal and Neonatal Health Program. Mat Child Health J. 2018;22(7):986-97.
Mbaruku G, Therrien MS, Tillya R, Mbuyita S, Mtema Z, Kinyonge I, Godfrey R, Temu S, Miller S. Implementation project of the non-pneumatic anti-shock garment and m-communication to enhance maternal health care in rural Tanzania. Reproduct Health. 2018;15(1):177.
Gebrehiwot Y. Use of the Non-Pneumatic Anti-shock Garment (NASG) to Reduce Maternal Mortality in Ethiopia. Ethiopia: Tewodros Emiru; 2013. PLoS ONE. 8(4):e62282.
Zeidou A. Lutte contre la mortalite maternal: Experience du Niger. Lome, Togo: Presentation at Togo Ministry of Health Postpartum Hemorrhage Technical Meeting; 2017.
Sharma J, Negandhi P, Das AM, Sethy G, Neogi BS. Using nonpneumatic anti-shock garment for postpartum hemorrhage management and referral at the public health facilities: A pilot study in two districts of Bihar. Indian J Public Health 2016;60(4):316-22.