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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
INTRODUCTIONINTRODUCTIONMMR: 397 DEATHS/ 100 000 live
birthsMAJOR CAUSES OF MATERNAL
DEATHS:◦ HEMORRHAGE◦ ECLAMPSIA◦ INFECTION (SEPSIS)◦ ABORTION◦ OBSTRUCTED LABOR
MMR : Maternal Mortality Ratio
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
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
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))
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
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
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
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
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
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).
SUPERVISIONSUPERVISIONTrainers Clinical supervisorsQualified care providers serving in
maternity hospitals
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)
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
Thanks !!
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