Multifaceted intervention to decrease the rate of severe postpartum haemorrhage: the PITHAGORE6 cluster-randomised controlled trial

Autor: Deneux-Tharaux , Catherine, Dupont , Corinne, Colin , C., Rabilloud , Muriel, Touzet , S., Lansac , Jacques, Harvey , Thierry, Tessier , Véronique, Chauleur , C., Pennehouat , G., Morin , X., Bouvier-Colle , Marie-Hélène, Rudigoz , René
Přispěvatelé: Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants ( UMR_S 953 ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Université Paris-Sud - Paris 11 ( UP11 ), Santé Individu Société - SIS ( SIS ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Jean Monnet [Saint-Étienne] ( UJM ) -Hospices Civils de Lyon ( HCL ) -Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Université Jean Moulin - Lyon III ( UJML ) -Université Lumière - Lyon 2 ( UL2 ), Réseau périnatal Aurore, Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon ( HCL ) -Hospices Civils de Lyon ( HCL ), Département d'information médicale et évaluation des soins de santé, Hospices Civils de Lyon ( HCL ), Laboratoire de Biométrie et Biologie Evolutive ( LBBE ), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique ( Inria ) -Centre National de la Recherche Scientifique ( CNRS ), Service de Biostatistique, Réseau périnatal PerinatCentre, CHRU Tours, Réseau périnatal port-royal, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Saint-Vincent de Paul, Réseau périnatal Loire Nord Ardeche, CHU Saint-Etienne, Réseau périnatal Savoie, CHU Chambéry, Réseau périnatal Alpes Isère, CHU Grenoble, French ministry of health under its clinical research Hospital program (contract n°27-35)
Jazyk: angličtina
Rok vydání: 2010
Předmět:
Zdroj: BJOG An International Journal of Obstetrics and Gynaecology
BJOG An International Journal of Obstetrics and Gynaecology, 2010, 117 (10), pp.1278-87. 〈10.1111/j.1471-0528.2010.02648.x〉
DOI: 10.1111/j.1471-0528.2010.02648.x〉
Popis: International audience; OBJECTIVE: Decreasing the prevalence of severe postpartum haemorrhages (PPH) is a major obstetrical challenge. These are often considered to be associated with substandard initial care. Strategies to increase the appropriateness of early management of PPH must be assessed. We tested the hypothesis that a multifaceted intervention aimed at increasing the translation into practice of a protocol for early management of PPH, would reduce the incidence of severe PPH. DESIGN: Cluster-randomised trial. POPULATION: 106 maternity units in six French regions. METHODS: Maternity units were randomly assigned to receive the intervention, or to have the protocol passively disseminated. The intervention combined outreach visits to discuss the protocol in each local context, reminders, and peer reviews of severe incidents, and was implemented in each maternity hospital by a team pairing an obstetrician and a midwife. MAIN OUTCOME MEASURES: The primary outcome was the incidence of severe PPH, defined as a composite of one or more of: transfusion, embolisation, surgical procedure, transfer to intensive care, peripartum haemoglobin decrease of 4 g/dl or more, death. The main secondary outcomes were PPH management practices. RESULTS: The mean rate of severe PPH was 1.64% (SD 0.80) in the intervention units and 1.65% (SD 0.96) in control units; difference not significant. Some elements of PPH management were applied more frequently in intervention units-help from senior staff (P = 0.005), or tended to - second-line pharmacological treatment (P = 0.06), timely blood test (P = 0.09). CONCLUSION: This educational intervention did not affect the rate of severe PPH as compared with control units, although it improved some practices.
Databáze: OpenAIRE
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