Impact of Skill Development Training in the Management of Postpartum Hemorrhage

Background: Postpartum hemorrhage (PPH) is blood loss of 500 ml or more following birth of the baby. This study aimed to determine the impact of skills development training in the management of postpartum hemorrhage. Methods: It was an observational before-and-after study that was conducted in Paropakar Maternity and women’s Hospital. Training regarding management of PPH was given to 65 doctors from July to September 2020. Pre and post-training analysis of the trainees was done. Utilization of the skills that participants gained during training, and the changes in maternal morbidity and mortality related to PPH in the year prior to the training (year 2019) and after the training (year 2022) were recorded. A Chi square test was done to evaluate the p- value and value of <0.05 was considered significant. Odds ratio was calculated. Krickpatrick four level model was used to evaluate the impact of training. Results: There was a vast improvement in pre and post-training scores (29.5% vs 72.5%). A significant reduction in the rate of blood transfusion (41% vs 17.2% p= 0.0001, OR= 0.29), ICU admission (7%vs 1.7%, p=0.0001, OR=0.20) and peripartum hysterectomy (1.3 vs 0.04%, p=0.03, OR=0.28) was found. Similarly, condom tamponade placement, bimanual compression and application of compression suture increased post-training (67 vs 167, 56 vs 108 and 5 vs 12). Most importantly, maternal mortality due to postpartum hemorrhage dropped from 75% to 0%. Conclusion: The skill development training for health care workers was associated with a reduction in morbidity and mortality in patients with postpartum hemorrhage.