To analyze the performance of simulation training for acute and severe postpartum hemorrhage in reducing the mortality rate of postpartum hemorrhage in a city.

From July 2018 to September 2019, a 3-day simulation training of acute and severe postpartum hemorrhage was conducted for total 228 obstetric clinicians in a prefecture level city of Guangdong Province. The training included theoretical training, single operation training, team first aid drill, team first aid group demonstration, clinical skill operation, personnel division and station management training. The first aid skill operation, team cooperation and first aid operation time based on the changes of scores were assessed by the self-designed evaluation from including 14 items before and after training. The statistical methods in this study such as mean±standard deviation, percentage, independent sample T test, Wilcoxon paired signed rank sum test and other methods were applied to describe and analyze according to the variable type.

(1) Emergency operation score: estimated postpartum hemorrhage after training [(2.56±1.54) points and (4.56±1.87) points in 2018, (3.56±1.54) points and (4.56±1.68) points in 2019]. Timely appeal score: [(2018, (4.12±0.58) points and (4.72±1.12) points, 2019, (4.32±0.68) points and (4.92±1.35) points]. Scores of vital signs management: [2018 (4.28±0.58) points and (4.58±0.58) points, 2019 (4.46±0.78) points and (4.78±1.23) points]. Cause analysis score of postpartum hemorrhage: [2018 (4.25±1.65) points and (4.55±1.98) points, 2019 (4.35±1.32) points and (4.55±1.98) points]. Treatment and blood transfusion treatment score: [2018 (3.25±1.78) points and (4.25±1.85) points, 2019 (3.85±1.18) points and (4.25±1.85) points]. The five scores were significantly improved compared with those before training (P<0.05). (2) Team collaboration score: clear division of labor [2018 (2.24±0.68) points and (4.14±1.21) points, 2019 (3.24±1.18) points and (4.14±1.21) points]. Personnel positions were reasonable [(2.56±1.57) and (4.16±1.47) in 2018 and (3.56±1.42) and (4.36±1.24) in 2019]. Rapid and orderly [(3.78±1.56) points and (4.25±1.68) points in 2018, (4.18±1.04) points and (4.55±1.67) points in 2019]. Communication reports [2018 (3.25±0.89) vs. (4.55±1.68), 2019 (3.89±1.23) vs. (4.85±1.85)]. The scores of the four aspects were significantly improved after training, and the difference was statistically significant (P<0.05). (3) Operation time score: total rescue time [(1865±89.57) s and (1665±96.32) s in 2018, (1796±58.57) s and (1565±87.32) s in 2019]. The starting time of calling for help [(162±34.47) s and (113±52.68) s in 2018, (154±57.47) s and (112±45.68) s in 2019]. Treatment time for postpartum hemorrhage [(287±56.87) s and (217±47.56) s in 2018, (252±58.87) s and (215±48.36) s in 2019]. The establishment time of effective venous pathway [(182±39.57) s and (162±65.84) s in 2018, (156±34.65) s and (120±35.68) s in 2019]. The start time of capacity management [(198±65.78) s and (168±48.95) s in 2018, (156±25.89) s and (122±41.32) s in 2019] was significantly shortened, and the difference between the scores after training and those before training was statistically significant (P<0.05). From 2017 to 2019, the incidence of postpartum hemorrhage in the city was 3.37%, 2.57% and 1.90%, respectively, and the mortality was 2.38/100, 000, 0 and 0, respectively, showing a decreasing trend year by year.

Simulation training of obstetric emergency and critical care can significantly reduce the mortality rate of postpartum hemorrhage in the city.