postpartum hemorrhage prevention benin experience prof. r-x perrin, prof. ag. s. adisso, dr. s....
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POSTPARTUM POSTPARTUM HEMORRHAGE HEMORRHAGE PREVENTION PREVENTION
BENIN EXPERIENCE BENIN EXPERIENCE
Prof. R-X PERRIN, Prof. Ag. S. ADISSO, Prof. R-X PERRIN, Prof. Ag. S. ADISSO, Dr. S. Dr. S. ABOUDOUABOUDOU
Addis – Ababa, 2011Addis – Ababa, 2011
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INTRODUCTIONINTRODUCTIONMMR: 397 DEATHS/ 100 000 live
birthsMAJOR CAUSES OF MATERNAL
DEATHS:◦ HEMORRHAGE◦ ECLAMPSIA◦ INFECTION (SEPSIS)◦ ABORTION◦ OBSTRUCTED LABOR
MMR : Maternal Mortality Ratio
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INTRODUCTIONINTRODUCTION1999: EmOC 2003: Prevention of postpartum
hemorrhage initiative (introduction of AMTSL)
2007: AMTSL national survey2009: Joint statement for
prevention of PPH signed by midwifery and ob/gyn associations
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IMPLEMENTATION STEPSIMPLEMENTATION STEPSNational level action plan developedAMTSL integrated into clinical guidelinesFinancial resources mobilizedTraining strategy developedLearning materials validatedAMTSL integrated into supervisory toolsStudies implemented
AMTSL : Active Management of the Third Stage of Labor
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Studies Studies Two studies initiated in Benin
validated international studies showing the benefits of AMTSL ◦ One study comparing physiologic
and active management of the third stage of labor (University Centre of Gynecology and Obstetrics (CUGO))
◦ A second study with AMTSL as routine practice (Hôpital de la Mère et de l’Enfant – Lagune ‘’Mother and Child Hospital’’ (HOMEL))
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Baseline data
Final Assessment
Number % Number %
Vaginal delivery
6628 100 6186 100
Vaginal Delivery with AMTSL
-- -- 4687 76
Cases of PPH 414 6.2 153 2.4
Deaths from PPH
21 0.31 12 0.19
POSTPARTUM HEMORRHAGE POSTPARTUM HEMORRHAGE STUDY RESULTS at HOMELSTUDY RESULTS at HOMEL
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TRAINING CARE TRAINING CARE PROVIDERSPROVIDERSTraining of trainers:
◦ Sub regional training in Bamako, Mali (PRIME II) - 2 national trainers for Benin
◦ National training of trainersTraining of providers:
◦ Midwives and Obstetrician/Gynecologists serving in maternity hospitals
◦ Ideally all birth attendants serving in public and private maternity hospitals
Integration of AMTSL into pre-service curricula for midwives and physicians
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TRAINING METHOD TRAINING METHOD
Humanistic approachCompetency-based:
◦ Validation of theoretical knowledge (nac: 85%)
◦ Demonstration on manikin◦ Pratice in delivery room(in vivo)◦ Qualification: All providers who
meet the minimum criteria
NAC : Acceptable Level of Knowledge
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Providers trainedProviders trained
33/34 Health Zones : 97%2461 Care Providers Trained
◦ 1500 Midwives◦ 480 Health Nurses◦ 220 State Registered Nurses◦ 19 Nurses’ Aides◦ 82 Obstetrician/gynecologists◦ 60 General Practitioners
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SUCCES FACTORSSUCCES FACTORS
• Development Partners• National Budget (Ministry of
Health / Directorate of Health of the Mother and Child)
• Health Zones Budget (EmOC)• Training Mobile Team
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SUCCES FACTORSSUCCES FACTORS
• Involvement of Doctors Coordinators / Administrative Staff
• Training fellowship (funded at no cost)
• Tutoring (Monitoring and Correcting of Imperfection in the delivery room on the site - 2 weeks).
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SUPERVISIONSUPERVISIONTrainers Clinical supervisorsQualified care providers serving in
maternity hospitals
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RESULTS (THE 3 AMTSL GESTURES)RESULTS (THE 3 AMTSL GESTURES)
0%
20%
40%
60%
80%
100%
Enregistrement des donnees
Prevention des infections
Administration de l’oxytocin
Traction controlee du
cordon
Massage uterine
GATPA Globale
98%
26%21% 21%
29%33%
94%
45%
88% 90%93%
79%
Enquete de base (n=63) Evaluation f inale (n=52)
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CONCLUSIONCONCLUSIONMOH pushing PPH prevention agendaPublic and private sector involvedPostpartum hemorrhage prevention
effective in BeninCoverage in correct AMTSL brought to
22% in 2010Extension in process in order to maintain
continuity Follow up and better practice hoped forImplication of reinforcement by SGOBT
and ASFB
SGOBT : Gynecology and Obstetrics Society of Benin-Togo ASFB : Benin Midwives Association
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Thanks !!