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Can inter-professional simulation training influence the frequency of blood transfusions after birth?

Egenberg S, Øian P, Bru LE, Sautter M, Kristoffersen G, Eggebø TM.

Acta Obstet Gynecol Scand. 2014 Dec 24. doi: 10.1111/aogs.12569.

[Epub ahead of print]

 

Editor’s comment: Prof. Jim Thornton: Simulation training may reduce use of postnatal blood transfusion
Training obstetricians and midwives in emergency drills using birth simulators is popular.  This study suggests that it is also effective, at least in reducing the use of blood transfusion after birth related haemorrhage.

Abstract
OBJECTIVE:

To investigate whether interprofessional simulation training influenced the rate of red blood cell (RBC) transfusions after birth.

DESIGN:
Two cohorts were compared retrospectively using a pre-post design.

SETTING:
Norwegian university hospital with 4800 deliveries annually.

POPULATION:
Women with estimated blood loss >500 ml within 24 hours after birth in 2009 and 2011. Methods In 2010, all maternity staff attended a six hour, scenario-based training on emergency obstetrics including post-partum hemorrhage, using a birthing simulator. The simulation focused on prevention, identification and treatment of post-partum hemorrhage and on communication and leadership. Debrief immediately after the scenarios involved reflection and self-assessment.

MAIN OUTCOME MEASURES:
The frequency of women receiving RBC transfusions as a marker for blood loss. Secondary outcome was the frequency of surgical procedures in the management of post-partum hemorrhage.

RESULTS:
In 2009, 111/534 (20.8%) women with estimated blood loss >500 ml after birth received RBC transfusions vs. 67/546 (12.3%) in 2011 (p<0.01). The adjusted odds ratio for women receiving RBC transfusions in 2011 vs. 2009 was 0.53 (95% CI 0.38-0.74). Parity, oxytocin augmentation, duration of second stage, episiotomy, operative vaginal delivery and sphincter injury were included in the final model. The odds ratio was stable in all combinations of possible confounders. We observed a significant reduction in the frequencies of curettage (p<0.01) and uterine artery embolisations (p=0.01).

CONCLUSION:
We found a significant reduction in RBC transfusions after birth, which might be associated with mandatory simulation training. A causal link cannot be documented because of complex interactions of several variables. This article is protected by copyright. All rights reserved.

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