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A Qualitative Study to Investigate Provider Experiences after Introduction of B-Lynch Suture and Uterine Balloon Tamponade in a LMIC Nicaragua

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A hands-on simulation based educational program was found to be a successful model to teach proven life saving techniques to advanced practice physicians in a LMIC. B-lynch suture was more easily adopted than the use of UBT. Overcoming the
barriers for UBT at each site should be explored and addressed during the training process.

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A Qualitative Study to Investigate Provider Experiences after Introduction of B-Lynch Suture and Uterine Balloon Tamponade in a LMIC Nicaragua

  1. 1. A Qualitative Study to Investigate Provider Experiences after Introduction of B-Lynch Suture and Uterine Balloon Tamponade in a LMIC- Nicaragua Elena Bryce MD1, Kay Daniels MD1 1 Dept of Obstetrics and Gynecology Stanford Health Care BACKGROUND Nicaragua is the second poorest country in the Western hemisphere with a maternal mortality of 95/100,000 births in comparison with the USA rate of 17/100,000 births. The institution chosen for this study was Hospital Escuela Oscar Danilo Rosales Arguello (HEODRA) a public teaching hospital that performs >5000 deliveries a year. The training program participants consisted of 28 residents and 21 faculty. B lynch hemostatic suture and uterine balloon tamponade (UBT) are proven techniques for the control of postpartum hemorrhage (PPH) in high-resource areas. Unfortunately, these techniques have not consistently spread to many LMIC where PPH is often the leading cause of maternal mortality. To overcome these barriers, a simulation-based program aimed at management of PPH has been developed (GO MOMS). A qualitative study was performed to evaluate the impact of this program by assessing provider experiences with B-lynch and UBT in Nicaragua METHODS FINDINGS CONCLUSIONS A hands-on simulation based educational program was found to be a successful model to teach proven life saving techniques to advanced practice physicians in a LMIC. B-lynch suture was more easily adopted than the use of UBT. Overcoming the barriers for UBT at each site should be explored and addressed during the training process. A series of in-country simulation-based education courses on the management of PPH were provided to the residents and staff of a major government teaching hospital in Le�n, Nicaragua from 2013-2015.This course was the first exposure any of the providers had to B-lynch or UBT. In 2017 a follow-up study was performed using semi-structured interviews. Subjects were selected via a convenience sample of residents and attendings who had performed either B-Lynch or UBT or both. Subjects signed an informed consent form prior to the interview, and did not receive any compensation for their participation. Surveys were completed by 11 obstetric providers (3 attendings and 8 residents) Pooled responses indicated that 25 B-lynch sutures had been performed since the start of the program. 21/25 of these were successful, while 4/25 were unsuccessful and hysterectomy was performed. Lack of appropriate suture was the main barrier to B- lynch use. UBT was performed only 8 times in the same time period. Concerns about time needed to gather the necessary material and delaying a move to the operating room were the most commonly cited barrier to UBT uptake.

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