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 !!