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Fernando Althabe

Uniject, Training and Reminders to Increase the Use of Prophylactic Oxytocin for the Management of the Third Stage of Labor in Latin America. Institute for Clinical Effectiveness and Health Policy (IECS) , Buenos Aires, Argentina. Fernando Althabe.

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Fernando Althabe

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  1. Uniject, Training and Reminders to Increase the Use of Prophylactic Oxytocin for the Management of the Third Stage of Labor in Latin America Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina Fernando Althabe Tackling the biggest maternal killer: Progress and challenges in preventing postpartum hemorrhage Woodrow Wilson International Center for Scholars Washington, DC Friday, November 20, 2009

  2. A behavioral intervention to improve adoption of evidence-based clinical care: the Global Network Guidelines Trial Fernando Althabe José M Belizán Pierre Buekens Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina School of Public Health and Tropical Medicine, Tulane University Global Network for Women’s and Children’s Health Research

  3. Objective • To design an evaluate a multifaceted behavioral intervention to facilitate the adoption of evidence-based practices in Latin American maternity hospitals

  4. The Intervention The Intervention • Implementation & • maintenance • Training • Reminders • Audit & feedback • Selection of opinion leaders • Peer nomination • 3 - 6 per hospital • Guideline dissemination • Academic detailing • Computer and bibliography • Guidelines workshop • Development • Training on academic detailing Formativeresearch

  5. Trial Design and Timeline

  6. Follow-up at one yearActive management

  7. Follow-up at one year Episiotomy

  8. Following questions • Is this intervention feasible in other settings? • Can the effects be replicated? • CAMBIO project • Can we simplify the intervention an still show effect? • Uniject study

  9. Uniject, Training and Reminders Intervention

  10. Oxytocin Unijects BIOL, Argentina

  11. Training • Evidence on prophylactic oxytocin • How to administer • Vials & syringes • Unijects • Training using JHPIEGO model • 2-3 hs

  12. Use of Reminders

  13. Methods- Study Design Use of Prophylactic Oxytocin Baseline Intervention 80% 60% 40% 10% Presentationseminar 0 1 3 5 6 7 8 4 9 2 10 11 12 Month of data collection

  14. Setting • 5 1st-2nd level maternity hospitals • Province of Corrientes

  15. Outcome Measures Primary outcome: Rate of use of prophylactic oxytocin Secondary outcomes: Use of controlled cord traction Use of uterine massage Rate of use of oxytocin through Uniject Maternal admissions to ICU, blood transfusions, and post-partum interventions Birth attendants’ views of AMTSL and acceptability of Uniject

  16. Maternal and Childbirth Characteristics * Mean and S.D of the women. ** Median of the rates of the five hospitals [Minimum - Maximum]

  17. Results * Median of the rates of the 5 hospitals ** The median of the differences is calculated based on the difference between the intervention rate and the baseline rate for each hospital.

  18. Rates of use of prophylactic oxytocin by month and by hospital

  19. Maternal outcomes

  20. Survey to birth attendants

  21. Preliminary Conclusions • The 3-component intervention is feasible in the context of small maternity hospitals. • It is probably effective to increase the use of prophylactic oxytocin, CCT and uterine massage. • Uniject was well accepted and used by birth atendants

  22. Thank you! falthabe@iecs.org.ar

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