Variation in severe postpartum hemorrhage management: A national vignette-based study,PLOS ONE

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Variation in severe postpartum hemorrhage management: A national vignette-based study
PLOS ONE ( IF 2.9 ) Pub Date : 2018-12-13 , DOI: 10.1371/journal.pone.0209074
Anne Rousseau _{1,

2} , Patrick Rozenberg _{1,

3} , Elodie Perrodeau _{2,

4} , Philippe Ravaud _{2,

4}

Affiliation

Objectives

To assess variations in management of severe postpartum hemorrhage: 1) between obstetricians in the same situation 2) by the same obstetrician in different situations.

Study design

A link to a vignette-based survey was emailed to obstetricians of 215 maternity units; the questionnaire asked them to report how they would manage the PPH described in 2 previously validated case-vignettes of different scenarios of severe PPH. Vignette 1 described a typical immediate, severe PPH, and vignette 2 a less typical case of severe but gradual PPH. They were constructed in 3 successive steps and included multiple-choice questions proposing several types of clinical practice options at each step. Variations in PPH were assessed in a descriptive analysis; agreement about management and its timing between vignette 1 and vignette 2 was assessed with the Kappa coefficient.

Results

Analysis of complete responses from 119 (43.4%) obstetricians from 53 (24.6%) maternity units showed delayed or inadequate management in both vignettes. While 82.3% and 83.2% of obstetricians (in vignettes 1 and 2, respectively) would administer oxytocin 15 minutes after PPH diagnosis, only 52.9% and 29.4% would alert other team members. Management by obstetricians of the two vignette situations was inconsistent in terms of choice of treatment and timing of almost all treatments.

Conclusion

Case vignettes demonstrated inadequate management as well as variations in management between obstetricians and in different PPH situations. Protocols or procedures are necessary in all maternity units to reduce the variations in practices that may explain a part of the delay in management that leads to PPH-related maternal mortality and morbidity.

中文翻译：

严重产后出血处理的变化：一项基于国家小插曲的研究

目标

评估严重产后出血治疗的差异：1）相同情况下产科医生之间的差异；2）同一产科医生在不同情况下的治疗差异。

研究设计

基于小插图的调查链接已通过电子邮件发送给 215 个产科单位的产科医生；调查问卷要求他们报告如何管理 2 个先前验证的不同严重 PPH 场景的案例片段中描述的 PPH。小插图 1 描述了典型的立即严重 PPH，小插图 2 描述了不太典型的严重但渐进的 PPH 病例。它们是通过 3 个连续步骤构建的，包括多项选择题，在每个步骤中提出几种类型的临床实践选项。通过描述性分析评估 PPH 的变化；使用 Kappa 系数评估小插图 1 和小插图 2 之间关于管理及其时间安排的一致性。

结果

对来自 53 个 (24.6%) 产科单位的 119 名 (43.4%) 产科医生的完整回复进行的分析显示，这两个小插曲均存在延迟或管理不充分的情况。虽然 82.3% 和 83.2% 的产科医生（分别在插图 1 和 2 中）会在 PPH 诊断后 15 分钟内使用催产素，但只有 52.9% 和 29.4% 的产科医生会提醒其他团队成员。产科医生对这两种情况的处理在治疗选择和几乎所有治疗的时间安排方面都不一致。