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THE IMPACT OF ADVANCED LIFE SUPPORT IN OBSTETRICS (ALSO®) TRAINING IN LOW-RESOURCE COUNTRIES

ANN EVENSEN, MD 1 ; BJARKE LUND SORENSEN, MD, PHD 2 ; CAROLINA BUSTILLO, MD 3 ; DIANA WINSLOW, RN, BSN 4 ; GALO SANCHEZ 5 ; JIM DAMOS, MD 6 ; JOAO BATISTA, MD 7 ; JOHN BEASLEY, MD 6 ; JONATHAN SCHWARTZ, DO, MSPH 8 ; JOSÉ ANTONIO ROJAS-SUAREZ, MD 9 ; LAWRENCE LEEMAN, MD, MPH 10 ; LEE T DRESANG 6 ; MARCOS YMAYO, MD 7 ; MARIA MERCEDES ANCHETA GONZALEZ 11 ; MARIO PEREZ 12 ; MARK DEUTCHMAN, MD 13 ; NORMA GONZÁLEZ DE ANCHETA, MD 14 ; SHIELA BLOOMQUIST, MD 15
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• Introduction and Objective The Advanced Life Support in Obstetrics (ALSO) provider course is a two-day training incorporating lectures, case-based workshops, simulations with mannequins, and mnemonics developed to teach maternity caregivers evidence-based management of obstetrical emergencies. The training goals are to improve patient care and to increase clinicians’ comfort managing these emergencies. A number of studies have demonstrated effectiveness in increasing provider comfort with obstetrical emergencies in high resource settings. The objective of this study is to highlight new data regarding ALSO’s effect on obstetric outcomes in four low-resource areas. • Methods Colombian, Guatemalan and Honduran research groups performed single-center, longitudinal cohort studies. A Tanzanian group performed an uncontrolled, prospective trial with direct observations of clinical outcomes. • Results and Conclusions Following the introduction of ALSO, a Colombian obstetric center had an increase in recorded maternal morbidity and near misses and a corresponding decrease in maternal mortality. A regional hospital in Guatemala demonstrated a sustained decline in overall maternal mortality and mortality from postpartum hemorrhage (PPH). In Honduras, there was a significant decrease in episiotomy rates and increase in active management of the third stage of labor (AMTSL), vacuum-assisted delivery and reported comfort managing obstetric emergencies. A Tanzanian trial demonstrated improvement in PPH management and a halving in incidence of PPH and severe PPH. ALSO training is associated with decreased in-hospital maternal mortality, episiotomy use and PPH. The utilization of AMTSL and vacuum-assisted vaginal delivery increased following ALSO training.