Lee T Dresang1, María Mercedes Ancheta González2, John Beasley3, Maura Carolina Bustillo4, Jim Damos3, Mark Deutchman5, Ann Evensen3, Norma González de Ancheta2, José A Rojas-Suarez6, Jonathan Schwartz7, Bjarke L Sorensen8, Diana Winslow9, Lawrence Leeman10. 1. Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. Electronic address: lee.dresang@fammed.wisc.edu. 2. Department of Family Medicine, Universidad San Carlos de Occidente, Quetzaltenando, Guatemala. 3. Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. 4. Department of Obstetrics and Gynecology, Hospital Escuela, Tegucigalpa, Honduras. 5. Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA. 6. Department of Obstetric Medicine, Intensive Care and Obstetric Investigation Group, Sociedad Colombiana de Anestesiologia y Reanimación, Cartagena, Colombia. 7. Department of Pediatrics, Wayne State University, Detroit, MI, USA. 8. Department of Obstetrics and Gynecology, Centre for Innovative Medical Technology, Department of Clinical Research, Odense University Hospital and University of Southern Denmark, Odense, Denmark. 9. American Academy of Family Physicians, Leawood, KS, USA. 10. Department of Family and Community Medicine, Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM, USA.
Abstract
OBJECTIVE: To examine the effects of the Advanced Life Support in Obstetrics (ALSO) program on maternal outcomes in four low-income countries. METHODS: Data were obtained from single-center, longitudinal cohort studies in Colombia, Guatemala, and Honduras, and from an uncontrolled prospective trial in Tanzania. RESULTS: In Colombia, maternal morbidity and the number of near misses increased after ALSO training, but maternal mortality decreased. In Guatemala, sustained reductions in overall maternal mortality and mortality from postpartum hemorrhage (PPH) were recorded after ALSO implementation. In Honduras, there was a significant decrease in episiotomy rates, and increases in active management of the third stage of labor (AMTSL), vacuum-assisted delivery, and reported comfort managing obstetric emergencies. In Tanzania, the frequency of PPH and severe PPH decreased after training, while management improved. CONCLUSION: In low-income countries, ALSO training was associated with decreased in-hospital maternal mortality, episiotomy use, and PPH. AMTSL and vacuum-assisted vaginal delivery increased in frequency after ALSO training.
OBJECTIVE: To examine the effects of the Advanced Life Support in Obstetrics (ALSO) program on maternal outcomes in four low-income countries. METHODS: Data were obtained from single-center, longitudinal cohort studies in Colombia, Guatemala, and Honduras, and from an uncontrolled prospective trial in Tanzania. RESULTS: In Colombia, maternal morbidity and the number of near misses increased after ALSO training, but maternal mortality decreased. In Guatemala, sustained reductions in overall maternal mortality and mortality from postpartum hemorrhage (PPH) were recorded after ALSO implementation. In Honduras, there was a significant decrease in episiotomy rates, and increases in active management of the third stage of labor (AMTSL), vacuum-assisted delivery, and reported comfort managing obstetric emergencies. In Tanzania, the frequency of PPH and severe PPH decreased after training, while management improved. CONCLUSION: In low-income countries, ALSO training was associated with decreased in-hospital maternal mortality, episiotomy use, and PPH. AMTSL and vacuum-assisted vaginal delivery increased in frequency after ALSO training.
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