About the project- Background and purpose
Postpartum hemorrhage (PPH) is a serious obstetric emergency, and one of the top five causes of maternal mortality globally. In 2017, the American College of Obstetricians and Gynecologists revised their definition of PPH to consist of either of the following criteria: 1) Cumulative blood loss ≥1000 mL; or 2) Bleeding associated with signs or symptoms of hypovolemia within 24 hours of the birth process, regardless of the route of delivery (Committee on Practice Bulletins-Obstetrics, 2017). Thus, timely diagnosis, appropriate resources and early management are critical to prevent death (M Belfort, 2019). External, manual aortic compression is an emergency manoeuvre proposed to reduce postpartum haemorrhage and permit time for resuscitation and control of bleeding as well as help with preventing cardiac arrest from hypovolemia. The Swedish obstetrician Staffan Bergstrom has been teaching this life-saving technique for many years in African countries, with great effect (Aronsson & Bergstrom, 2012). However, in many countries, including Norway, manual aortic compression is not actively used by healthcare personnel. Furthermore, there is an increasing incidence of home births in Norway (Norwegian Institute of Public Health, 2017) and the COVID-19 pandemic has contributed further to this increase. This enlightens the challenges with distributing knowledge about handling of PPH to larger groups of personnel. Hence, a PPH-handling digital learning program has been developed, as well as a simulator that enables participants to evaluate the pressure, placement and effect of external, manual aortic compression.
Impact
The study will be conducted in two locations; the catchment area of Østfold Hospital Trust, and the other in a developmental country (location not decided at this time). The intervention will consist of a digital course and/or training on a new simulator. The course consists of both theory and clinical assessment of post parturients with PPH. The simulation will allow participants to train on aortic compressions on a specially designed simulator that indicates blood pressure, and needed pressure to stop bleeding.
The aims are to:
- evaluate self-assessed competence before and after conducting a digital course in PPH handling
- evaluate self-efficacy and team efficacy in PPH handling before and after a simulation, using the innovative simulator
Project’s timeline
01.04.20-31.12.23
Project Type/Financing
This clinical research study receives financial support through strategic fundings from research priority area, The Digital Society, at Østfold University College.
Collaboration Partners
- Østfold University College, Faculty of health and welfare
- Østfold Hospital Trust
- ExAc
- University of Alberta, Department of Critical Care Medicine
Publications
- Linqvist Leonardsen, A-C, Helgesen, AK, Ulvøy, L, Grøndahl, VA (2021). Prehospital assessment and management of postpartum haemorrhage- healthcare personnel's experiences and perspectives. BMC Emerg Med 21(1):98, 2021 Aug 28. (https://pubmed.ncbi.nlm.nih.gov/34454430/).
References
- Committee on Practice Bulletins-Obstetrics. (2017). Postpartum Hemorrhage. Practice Bulletin No. 183. Obstet Gynecol, 130(4), 168.
- Aronsson, A., & Bergstrom, S. (2012). Abdominal compression of the aorta effective in severe postpartum hemorrhage. Läkartidningen, 109(34-35), 1478-1480.
- Belfort, M. (2019). Overview of postpartum hemorrhage. UptoDate.
- Belfort, M. (2019). Postpartum hemorrhage: Management approaches requiring laparotomy.
- Norwegian Institute of Public Health. (2017). Medical birth register. Retrieved from http://statistikk.fhi.no/mfr/.