Interprofessional obstetric simulation training improves postpartum haemorrhage management and decreases maternal morbidity: a before‐and‐after study

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 131; no. 3; pp. 353 - 361
• Main Authors: Lutgendorf, Monica A., Ennen, Christopher S., McGlynn, Andrea, Spalding, Carmen N., Deering, Shad, Delorey, Donald R., Greer, Joy A.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-02-2024
• Subjects: Blood transfusion; clinical outcomes; Electronic medical records; Female; Hemorrhage; Hospitals; Humans; Hysterectomy; Length of stay; Maternal Health Services; Morbidity; obstetric simulation; Obstetrics; Postpartum; postpartum haemorrhage; Postpartum Hemorrhage - epidemiology; Postpartum Hemorrhage - therapy; Pregnancy; Simulation Training; team training; Tranexamic Acid - therapeutic use; postpartum haemorrhage; clinical outcomes; team training; obstetric simulation
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.17640

Objective
To determine the impact of the Obstetric Simulation Training and Teamwork (OB‐STaT) curriculum on postpartum haemorrhage (PPH) rates and outcomes.
Design
Before‐and‐after study.
Setting
Maternity care hospitals within the USA.
Population
Patients who delivered between February 2018 and November 2019.
Methods
Interprofessional obstetric teamwork training (OB‐STaT) conducted at each hospital. Electronic medical records for deliveries were reviewed for 6 months before and after conducting OB‐STaT at participating hospitals.
Main outcome measures
The PPH rate (blood loss of ≥1000 ml), uterotonic medications used, tranexamic acid use, blood product transfusion, hysterectomy, length of stay and composite maternal morbidity (postpartum haemorrhage, hysterectomy, transfusion of ≥4 units of blood products and intensive care unit admission for PPH).
Results
A total of 9980 deliveries were analysed: 5059 before and 4921 after OB‐STaT. The PPH rates did not change significantly (5.48% before vs 5.14% after, p = 0.46). Composite maternal morbidity decreased significantly by 1.1% (6.35%–5.28%, p = 0.03), massive transfusions decreased by 57% (0.42%–0.18%, p = 0.04) and the mean postpartum length of stay decreased from 2.05 days (1.05 days SD) to 2.01 days (0.91 days SD) (p = 0.04). Following OB‐STaT, haemorrhage medication use increased by 36% (14.8%–51.2%, p = 0.03), the use of tranexamic acid for PPH treatment almost doubled (2.7%–4.8%, p < 0.001) and the rate of hysterectomy significantly increased (0%–0.1%, p = 0.03).
Conclusions
Although the PPH rates did not decrease, OB‐STaT significantly improved maternal morbidity, decreased massive transfusions, and improved PPH management by increasing the utilization of uterotonic medications, tranexamic acid and hysterectomy.