To assess if simulation-based training (SBT) of B-lynch suture and uterine balloon tamponade (UBT) for the management of postpartum hemorrhage (PPH) impacted provider attitudes, practice patterns, and patient management in Guatemala, using a mixed-methods approach.
We conducted an in-country SBT course on the management of PPH in a governmental teaching hospital in Guatemala City, Guatemala. Participants were OB/GYN providers (n = 39) who had or had not received SBT before. Surveys and qualitative interviews evaluated provider knowledge and experiences with B-lynch and UBT to treat PPH. In addition, a retrospective chart review was performed to evaluate management of PPH over a 2-year period before and after the introduction of SBT.
Multiple-choice surveys indicated that providers who received SBT were more comfortable performing and teaching B-lynch compared to those who did not (p = 0.003 and 0.005). Qualitative interviews revealed increased provider comfort with B-lynch compared to UBT and identified multiple barriers to uterine balloon tamponade implementation. Chart review demonstrated an increased use of UBT after the introduction of simulation-based training, though not statistically significant (p = 0.06) in contrast to no change in B-lynch use.
Simulation-based training had a stronger impact on provider comfort with B-lynch compared to uterine balloon tamponade. Qualitative interviews provided insight into the challenges that hinder uptake of uterine balloon tamponade, namely resource limitations and decision-making hierarchies. Capturing data through a mixed-methods approach allowed for more comprehensive program evaluation in low and middle income countries (LMICs).