Promptness of oxytocin administration for first-line treatment of postpartum hemorrhage: a national vignette-based study among midwives
Abstract Background Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide. Midwives play a key role in the initial management of PPH. Uterotonic agents are widely used in its prevention and treatment, with oxytocin the first-line agent. Nonetheless, a stan...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-04-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | https://doi.org/10.1186/s12884-022-04648-5 |
| _version_ | 1828473656312856576 |
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| author | S. Voillequin P. Rozenberg Ph. Ravaud A. Rousseau |
| author_facet | S. Voillequin P. Rozenberg Ph. Ravaud A. Rousseau |
| author_sort | S. Voillequin |
| collection | DOAJ |
| description | Abstract Background Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide. Midwives play a key role in the initial management of PPH. Uterotonic agents are widely used in its prevention and treatment, with oxytocin the first-line agent. Nonetheless, a standardized guideline for optimal dose and rate of administration has not been clearly defined. The aim of this study was to investigate French midwives’ practices regarding first-line oxytocin treatment and the factors influencing its delayed administration. Methods This multicenter study was based on clinical vignettes of PPH management collected using an anonymous online questionnaire. A random sample of midwives from 145 maternity units in France from 15 randomly selected perinatal networks were invited to participate by email. The Previously validated case vignettes described two 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 three successive steps and included multiple-choice questions proposing several types of clinical practice options at each stage. For each vignette separately, we analyzed the lack of prompt oxytocin administration and the factors contributing to them, that is, characteristics of the midwives and organizational features of maternity units. Bivariate analysis and multivariable logistic regression analysis were applied. Results In all, 450 midwives from 87 maternity units provided complete responses. Lack of promptness was observed in 21.6% of responses (N = 97) in Vignette 1 and in 13.8% (N = 62) in Vignette 2 (p < .05). After multivariate analysis, the risk of delay was lower among with midwives working in university maternity hospitals (ORa 0.47, 95% 0.21, 0.97) and in units with 1500 to 2500 births per year (ORa 0.49, 95% CI 0.26, 0.90) for Vignette 1. We also noticed that delay increased with the midwives’ years of experience (per 10-year period) (ORa 1.30, 95% CI 1.01, 1.69). Conclusions This study using clinical vignettes showed delays in oxytocin administration for first-line treatment of PPH. Because delay in treatment is a major cause of preventable maternal morbidity in PPH, these findings suggest that continuing training of midwives should be considered, especially in small maternity units. |
| first_indexed | 2024-12-11T05:47:39Z |
| format | Article |
| id | doaj.art-874736ab3f1e4c5a8eb5f0b7320ac171 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-12-11T05:47:39Z |
| publishDate | 2022-04-01 |
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| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-874736ab3f1e4c5a8eb5f0b7320ac1712022-12-22T01:18:55ZengBMCBMC Pregnancy and Childbirth1471-23932022-04-0122111010.1186/s12884-022-04648-5Promptness of oxytocin administration for first-line treatment of postpartum hemorrhage: a national vignette-based study among midwivesS. Voillequin0P. Rozenberg1Ph. Ravaud2A. Rousseau3Department of Obstetrics and Gynecology, Strasbourg University HospitalINSERM UMR1018 “Clinical Epidemiology Team”, Research Center on Epidemiology and Population Health (CESP), UVSQ, Paris Saclay UniversityINSERM UMR1153, Centre of Research Epidemiology and Statistics (CRESS), Université de ParisINSERM UMR1018 “Clinical Epidemiology Team”, Research Center on Epidemiology and Population Health (CESP), UVSQ, Paris Saclay UniversityAbstract Background Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide. Midwives play a key role in the initial management of PPH. Uterotonic agents are widely used in its prevention and treatment, with oxytocin the first-line agent. Nonetheless, a standardized guideline for optimal dose and rate of administration has not been clearly defined. The aim of this study was to investigate French midwives’ practices regarding first-line oxytocin treatment and the factors influencing its delayed administration. Methods This multicenter study was based on clinical vignettes of PPH management collected using an anonymous online questionnaire. A random sample of midwives from 145 maternity units in France from 15 randomly selected perinatal networks were invited to participate by email. The Previously validated case vignettes described two 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 three successive steps and included multiple-choice questions proposing several types of clinical practice options at each stage. For each vignette separately, we analyzed the lack of prompt oxytocin administration and the factors contributing to them, that is, characteristics of the midwives and organizational features of maternity units. Bivariate analysis and multivariable logistic regression analysis were applied. Results In all, 450 midwives from 87 maternity units provided complete responses. Lack of promptness was observed in 21.6% of responses (N = 97) in Vignette 1 and in 13.8% (N = 62) in Vignette 2 (p < .05). After multivariate analysis, the risk of delay was lower among with midwives working in university maternity hospitals (ORa 0.47, 95% 0.21, 0.97) and in units with 1500 to 2500 births per year (ORa 0.49, 95% CI 0.26, 0.90) for Vignette 1. We also noticed that delay increased with the midwives’ years of experience (per 10-year period) (ORa 1.30, 95% CI 1.01, 1.69). Conclusions This study using clinical vignettes showed delays in oxytocin administration for first-line treatment of PPH. Because delay in treatment is a major cause of preventable maternal morbidity in PPH, these findings suggest that continuing training of midwives should be considered, especially in small maternity units.https://doi.org/10.1186/s12884-022-04648-5Oxytocin administrationTreatment guidelinesMidwivesCase-vignetteFirst-line treatment |
| spellingShingle | S. Voillequin P. Rozenberg Ph. Ravaud A. Rousseau Promptness of oxytocin administration for first-line treatment of postpartum hemorrhage: a national vignette-based study among midwives BMC Pregnancy and Childbirth Oxytocin administration Treatment guidelines Midwives Case-vignette First-line treatment |
| title | Promptness of oxytocin administration for first-line treatment of postpartum hemorrhage: a national vignette-based study among midwives |
| title_full | Promptness of oxytocin administration for first-line treatment of postpartum hemorrhage: a national vignette-based study among midwives |
| title_fullStr | Promptness of oxytocin administration for first-line treatment of postpartum hemorrhage: a national vignette-based study among midwives |
| title_full_unstemmed | Promptness of oxytocin administration for first-line treatment of postpartum hemorrhage: a national vignette-based study among midwives |
| title_short | Promptness of oxytocin administration for first-line treatment of postpartum hemorrhage: a national vignette-based study among midwives |
| title_sort | promptness of oxytocin administration for first line treatment of postpartum hemorrhage a national vignette based study among midwives |
| topic | Oxytocin administration Treatment guidelines Midwives Case-vignette First-line treatment |
| url | https://doi.org/10.1186/s12884-022-04648-5 |
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