Uterine model-based simulation training on uterine compression sutures placement for management of postpartum hemorrhage at Muhimbili National Hospital Dar es Salaam

Abstract

Background: In Postpartum hemorrhage, uterine compression sutures (UCS) are applied when pharmacological method fails to control bleeding due to uterine atony. UCS techniques were seldom used at Muhimbili National Hospital despite uterine atony being the second cause of peripartum hysterectomy, one of the causes being lack of practical training on UCS in the department. Thus, to impart knowledge and positive attitude on UCS, simulation training using mattress uterine model was done. Objective: To determine the effect of simulation training on self-perceived knowledge, skills, and attitude on uterine compression sutures placement for management of PPH at MNH Materials and method: An interventional cross-sectional study was done at MNH Upanga to all medical doctors working in the department. Mattress uterine models were used in the training. The training had a theory (PowerPoint presentation) and practical parts on B-Lynch, Hayman, and Cho compression suture placement techniques. Pre-tested pre and post-training self-administered structured questionnaires were used before and after training respectively. The participants reported self-perceived knowledge, skills and attitude (feel) to apply UCS through Yes/No and Likert-scale type questions. Wilcoxon matched-pairs signed-rank test was used to compare the median score before and after training. A p-value of < 0.05 was considered statistically significant.Results: Sixty-nine doctors participated in this training. Five (7.2%) were registrars, 49 (71.1%) residents and 15 (21.7%) were obstetricians. Nine (13.0%) reported they had UCS training with practical sessions and 33 (47.8 %) had applied UCSs in their practice. Statistically, there was a significant improvement in self-perceived knowledge, skills, and attitude on UCS after training to all participants (P < 0.001), whereas 69 (98.6%) agreed that such training was useful. Conclusion: Simulation training on uterine compression suture techniques using mattress uterine model showed improvement on self-perceived knowledge, skills and, attitude in applying UCS in management of PPH.UCS placement simulation training should be done regularly in the department to updates skill for newly recruited staffs and postgraduate students.