Competent Management of Postpartum Haemorrhage: A Review on Effective Training Methods

Abstract

Postpartum haemorrhage (PPH) is one of the most threatening and unpredictable emergencies in obstetrics. Worldwide it is a leading cause of maternal death. The outcome significantly depends on competent management by a skilled interdisciplinary team. For health professionals, PPH might cause stress, anxiety and inability to act adequately. It is estimated that 70-80% of maternal deaths related to PPH are due to preventable management errors. This leads to the conclusion that health professionals need training in order to competently manage a PPH emergency. The aim of this study is to summarise the evidence on the effectiveness of different training methods to support the professional and competent management of PPH. A systematic literature review was conducted. The search was performed on the data bases Cochrane Library, Embase, Medline, CINAHL complete and MIDIRS and was supplemented by hand searching. The selected studies were analysed and checked for content and quality based on specific criteria. The 11 included studies support the effectiveness of simulation training. The subjective indicators «self-confidence», «knowledge», «competence» «stress levels», «team work» and «communication» could be improved, as well as the objective indicators «team performance» and «knowledge». 3 studies could establish a sustainable effect of the simulation training 6 weeks, 3 months and 6 months, respectively, after the training session. However, in all included studies this effect was not tested in a clinical context. Therefore the clinical effectiveness of simulation-based training on clinical outcome is unknown. 2 studies indicate a benefit of simulation-based training versus the lecture and discussion-based method. In addition, no evidence exists as to whether the effectiveness of simulation-based training depends on high fidelity circumstances such as the location at which training is taking place (simulation centre vs. local obstetrics room) or whether it could be influenced by teamwork training. It is recommended to offer an interdisciplinary training on a regular basis even after accomplished graduation training of professionals in the field of obstetrics. No recommendations can be made concerning the type and frequency of training. There is an urgent need for more evidence related to the effectiveness of different training methods for adequate PPH management.