• Bjarke Lund Sorensen, Vibeke Rasch, Siriel Massawe, Juma Nyakina, Peter Elsass, and Birgitte Bruun Nielsen.
• Department of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, Denmark. bjarkebjarke@yahoo.dk
• Acta Obstet Gynecol Scand. 2011 Jun 1; 90 (6): 609-14.

ObjectiveTo evaluate the impact of Advanced Life Support in Obstetrics (ALSO) training on staff performance and the incidences of post-partum hemorrhage (PPH) at a regional hospital in Tanzania.DesignProspective intervention study.SettingA regional, referral hospital.PopulationA total of 510 women delivered before and 505 after the intervention.MethodsAll high- and mid-level providers involved in childbirth at the hospital attended a two-day ALSO provider course. Staff management was observed and post-partum bleeding assessed at all vaginal deliveries for seven weeks before and seven weeks after the training.Main Outcome MeasuresPPH (blood loss ≥500ml), severe PPH (blood loss ≥1000ml) and staff performance to prevent, detect and manage PPH.ResultsThe incidence of PPH was significantly reduced from 32.9 to 18.2%[RR 0.55 (95%CI: 0.44-0.69)], severe PPH from 9.2 to 4.3%[RR 0.47 (95%CI: 0.29-0.77)]. The active management of the third stage of labor was also significantly improved. There was a significant decrease in episiotomies. By visual estimation, staff identified one in 25 of the PPH cases before the ALSO training and one in five after the training. A significantly higher proportion of women with PPH had continuous uterine massage, oxytocin infusion and bimanual compression of the uterus after the training.ConclusionsA two-day ALSO training course can significantly improve staff performance and reduce the incidence of PPH, at least as evaluated by short-term effects.© 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

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