Analysis Of Maternal And Infant Outcomes Before And After The Multidisciplinary Scenario Simulation Training Of Obstetric Emergency In 6 Hospitals

BackgroundAcute and critical obstetric illness is the most important cause of perinatal maternal death,with a risk of about 15%in non-high-risk pregnant women.These emergencies are unexpected and progress rapidly once occur.Situationsimulation teaching for obstetricians,midwives,anesthesiologists and other mult-idisciplinary personnel training,the international is widely known as:obstetric emergency multidisciplinary simulation training.It has been rapidly promoted internationally,and in the domestic national,provincial and municipal obstetrics related professional conferences and continuing education projects,the obstetric critical illness treatment scenario simulation training has been widely promote-d;However,there are few multi-center studies,especially in the municipal and county medical institutions before and after training.PurposeThis study used a multicenter cohort study to explore the impact of mater-nal and infant outcomes using obstetric emergency and multidisciplinary team situational simulation training in municipal and county medical institutions.Study subjects and methods1.Study subjects:Between 2018-11-01 and 2020-12-30,a trained obstetric multidisciplinary team of 160 medical staff from six hospitals(three municipal medical institutions and three county-level medical institutions),including obstetricians,midwives,anesthesiologists,and neonatologists.Acting as the control group before the training and as the trial group after the training,the relevant maternal and infant clinical outcomes were statistically analyzed,and the teaching effect before and after the training was evaluated.2.Methods:Between 2018-11-01 and 2020-12-12-30,the multidisciplinary teams,including obstetrics,midwifery,anesthesiology,and neonatology departments,were trained twice.The training programs include postpartum hemorrhage,amniotic fluid embolism,vaginal midwifery,breech delivery,shoulder dystocia,and neonatal resuscitation.Statistics of relevant maternal and infant clinical outcomes after two training:theoretical and operational results before and after training,maternal mortality rate,postpartum bleeding rate,vaginal delivery rate,cesarean section rate,perineal incision rate,and neonatal asphyxia rate.Statistical methodsData processing was performed using the SPSS 25.0 software.Measurement data used X±s。Comparison of the sample mean in the 6 groups,if the data meet the normal distribution and have equal variance,the one-way analysis of variance is used;Non-normally distributed data are expressed as the median(minimum,maximum)。Counting data were described by frequency and rate,and differences between groups were compared byχ~2 test or correctedχ~2 test.Results1 Evaluation of training effectiveness1.1 Satisfaction survey86%of the trainees agree with the course content,71%are satisfied with the teaching methods and teaching level of the professional training team,60%are satisfied with the scene layout,79%think the training can gain more new knowledge and skills,96%think the training has significant clinical utility can be promoted clinically,and 96%have great help to improve the teamwork ability of clinical multiple departments.1.2 Theoretical and operational results before and after trainingThe average theoretical test score of the trainees before the training was 70.21±9.86 and after the training was 85.07±8.40.The written test score after the training was14.86±1.46 higher than that before the training,and the difference was statistically significant(P<0.05).After the training,the coordination of operation,judgment,help-seeking,operation and teamwork was significantly improved,and the difference was statistically significant(P<0.05).2 Maternal and infant situation2.1 GeneralA total of 33533 maternal women(There were 16398 cases before training and17135 cases after training)and 33748 newborns(There were 16451 cases before training and 17297 cases after training)were included in this study.The mean maternal age was 29.32±4.51 years,the mean gestational week was 39.12±2.45 weeks,the mean pregnancy was 1.87±1.12,and the average birth was 1.45±0.85.The average neonatal birth weight was 3402.75±526.74g.2.2 Maternal and child outcomesAmong the six medical institutions after the training,before and after the training,there were no maternal deaths in the six hospitals;The rate of cesarean section decreased from 46.65%to 44.38%,the perineal lateral shear rate decreased from 34.25%to 26.74%,the vaginal midwifery rate increased from 4.58%to 6.35%,the difference was statistically significant(P<0.05);Among municipal medical institutions,the cesarean section rate decreased from 51.48%to 48.67%,the perineal resection rate decreased from 35.08%to 20.91%,and the vaginal midwifery rate increased from 3.55%to 6.72%,the difference was statistically significant(P<0.05);The cesarean section rate in county-level hospitals decreased from 41.49%to 39.81%,with statistical differences(P<0.05),but there was no significant difference in the perineal resection rate and vaginal midwifery rate.Conclusion:In municipal and county medical institutions for obstetric emergency multidisciplinary scenario simulation teaching,the use of various situation simulation obstetric critical situation,can improve the municipal and county medical institutions medical aid ability and comprehensive quality,teamwork ability,improve obstetric quality and improve cesarean delivery rate,vaginal midwifery rate,postpartum bleeding rate.