失血监测图--产后出血检测和治疗的变革者:肯尼亚 7 家 E-MOTIVE 试验医院的直接观察研究

Polycarp Oyoo, Zahida Qureshi, Alfred Osoti, George Gwako, Jim Kelly Mugambi, Jennifer Okore, Joan Mwende
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引用次数: 0

摘要

背景:在资源匮乏的国家,每六分钟就有一名产妇死于产后出血(PPH)。PPH 的定义是失血量超过 500 毫升,是全球孕产妇死亡的主要原因,占孕产妇死亡人数的 27%。世界卫生组织于 2012 年发布了《预防和治疗产后出血建议》,为处理 PPH 提供了循证建议。然而,目前这些建议的实施受到了一些挑战的限制,其中包括产妇护理不善,尽管指南已经发布,但许多医疗服务提供者(HCPs)并未提供有效的护理,如正确监测生命体征,而这是血液动力学评估的关键,可促使早期干预。E-MOTIVE 试验为肯尼亚的 14 家医疗机构提供支持,其中 7 家为干预地点,7 家为对照地点。该试验引入了失血量监测图,以支持保健医生对胎盘娩出后的产妇进行评估,从而及早发现和治疗 PPH:失血监测工具/触发图表由伯明翰大学开发。该工具已在肯尼亚 7 家具备综合产科急诊能力(包括输血和剖宫产)的医院实施。在这些医院中,分娩、接生和产后护理主要由助产士和学生提供。资历较深的临床医生,包括医务人员和顾问医生(如产科医生、妇科医生和儿科医生)会定期巡视,并在紧急情况下随时待命提供帮助。数据收集时间为 2021 年 8 月至 2021 年 12 月。在现场研究助产士的支持下,试验实施助产士在每家研究医院进行了为期两周的观察。观察每天 24 小时进行。对患者的观察从胎盘娩出的第二阶段开始,直至胎盘娩出后两小时。所有数据均通过纸质表格收集,然后使用 RedCap 输入数字数据库:研究期间累计观察了 734 例分娩。所有产妇都在第一小时内使用失血监测表接受了四次临床观察。医护人员在监测过程中观察到校准帘布失血的频率为 94%。使用失血监测图对 PPH 的检测率为 100%:结论:为提高PPH的早期发现率和治疗率,应重视提高护理质量,尤其是PPH失血监测。失血量监测表易于使用,在资源匮乏的环境中很容易推广。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Blood loss monitoring chart, a game changer in postpartum hemorrhage detection and treatment: A direct observation study in 7 E-MOTIVE trial hospitals in Kenya
Background: Every six minutes, a mother dies of postpartum hemorrhage (PPH) in low-resource countries. PPH, defined as blood loss of more than 500 ml, is the leading cause of maternal death worldwide, accounting for 27% of maternal deaths. The WHO published “Recommendations for the Prevention and Treatment of Postpartum Hemorrhage” in 2012 to provide evidence-informed recommendations for managing PPH. However, adherence to these recommendations is currently limited by several challenges, including poor maternal care where despite guideline dissemination, many health care providers (HCPs) do not provide effective care such as proper monitoring of vital signs which is key in hemodynamic assessments that can prompt early intervention. The E-MOTIVE trial supported 14 health facilities in Kenya, 7 intervention and 7 control sites. The trial introduced a blood loss monitoring chart to support HCPs in assessing women after delivery of the placenta and enabling early detection and treatment of PPH. Methods: Blood loss monitoring tool/Trigger chart was developed by the University of Birmingham. This tool was implemented in seven hospitals in Kenya with the capacity for comprehensive emergency obstetric care, including blood transfusion and cesarean delivery. In these hospitals, labor, delivery, and postpartum care are primarily provided by nurse-midwives and students. More senior clinicians, including medical officers and consultant physicians such as obstetrician, gynecologists and pediatricians, make periodic rounds and are available on-call to assist in emergencies. Data were collected from August 2021 to December 2021. Observations were conducted by the trial implementation midwives with the support of the on-site research midwives for two weeks in each of the study hospitals. Observations occurred 24 hours a day. Patients were observed from the second stage up to two hours after placental delivery. All data were collected on paper forms and then entered into a digital database using RedCap. Results: A total of 734 deliveries were observed cumulatively during the study period. All women received four clinical observations within the first hour using the blood loss monitoring chart. The frequency of observing blood loss in the calibrated drapes during monitoring by HCPs was 94%. There was 100% detection of PPH using the blood loss monitoring chart. Conclusion: Efforts to increase the rates of early PPH detection and treatment should emphasize improvements in the quality of care, with a particular focus on PPH blood loss monitoring. The blood loss monitoring chart is easy to use and can be easily adopted and scaled in low-resource settings. 
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