日本母体救命システム協議会（J-CIMELS）講習会導入前後での産後異常出血搬送症例の比較検討：シミュレーション教育の普及は産後異常出血時の大量輸血を減少させるか
目的：鹿児島県では2018年から日本母体救命システム協議会ベーシックコース講習会の受講を推奨してきた．取り組み開始前後3年ずつの母体搬送症例の予後を比較しその効果を検討した． 方法：2015年1月〜2020年12月に鹿児島市立病院と鹿児島大学病院に1,000g以上の産後異常出血のために搬送となった症例を講習会導入前の前期（2015年〜2017年）と導入後の後期（2018年〜2020年）にわけ背景と転帰の比較を行った． 結果：前期63症例，後期105症例，後期で約1.7倍に増加していた．大量輸血を要する症例は46.0％から29.5％に減少した．多変量解析では，大量輸血に有意に関連する因子は講習会...
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| Published in | 日本周産期・新生児医学会雑誌 Vol. 60; no. 2; pp. 205 - 212 |
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| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本周産期・新生児医学会
2024
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1348-964X 2435-4996 |
| DOI | 10.34456/jjspnm.60.2_205 |
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| Abstract | 目的：鹿児島県では2018年から日本母体救命システム協議会ベーシックコース講習会の受講を推奨してきた．取り組み開始前後3年ずつの母体搬送症例の予後を比較しその効果を検討した． 方法：2015年1月〜2020年12月に鹿児島市立病院と鹿児島大学病院に1,000g以上の産後異常出血のために搬送となった症例を講習会導入前の前期（2015年〜2017年）と導入後の後期（2018年〜2020年）にわけ背景と転帰の比較を行った． 結果：前期63症例，後期105症例，後期で約1.7倍に増加していた．大量輸血を要する症例は46.0％から29.5％に減少した．多変量解析では，大量輸血に有意に関連する因子は講習会受講の有無，帝王切開分娩，2,200g以上の出血，凝固異常であり，J-CIMELS講習会受講は大量輸血のリスクを減少させるために有効であることが示唆された． |
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| AbstractList | 目的：鹿児島県では2018年から日本母体救命システム協議会ベーシックコース講習会の受講を推奨してきた．取り組み開始前後3年ずつの母体搬送症例の予後を比較しその効果を検討した． 方法：2015年1月〜2020年12月に鹿児島市立病院と鹿児島大学病院に1,000g以上の産後異常出血のために搬送となった症例を講習会導入前の前期（2015年〜2017年）と導入後の後期（2018年〜2020年）にわけ背景と転帰の比較を行った． 結果：前期63症例，後期105症例，後期で約1.7倍に増加していた．大量輸血を要する症例は46.0％から29.5％に減少した．多変量解析では，大量輸血に有意に関連する因子は講習会受講の有無，帝王切開分娩，2,200g以上の出血，凝固異常であり，J-CIMELS講習会受講は大量輸血のリスクを減少させるために有効であることが示唆された． |
| Author | 濵田, 朋紀 内藤, 喜樹 折田, 有史 前田, 隆嗣 切原, 奈美 上塘, 正人 谷口, 博子 太崎, 友紀子 橋本, 崇史 |
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| References | 2) Knight M, Callaghan WM, Berg C, et al.：Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International postpartum hemorrhage Collaborative Group. BMC Preg Childbirth 2009；9：55 3) Kramer MS, Berg C, Abenhaim H, et al.：Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstet Gynecol 2013；209：449.e1-449.e7 20) Hasegawa J, Katsuragi S, Tanaka H, et al.：Decline in maternal death due to obstetric haemorrhage between 2010 and 2017 in Japan. Sci Rep 2019；9：11026 25) Nathan HL, Cottam K, Hezelgrave NL, et al.：Determination of normal ranges of shock index and other haemodynamic variables in the immediate postpartum period: a cohort study. PLOS ONE 2016；11：e0168535 29) Rossen J, Okland I, Nilsen OB, et al.：Is there an increase of postpartum hemorrhage, and is severe hemorrhage associated with more frequent use of obstetric interventions? Acta Obstet Gynecol Scand 2010；89：1248-1255 19) Kirkpatrick D：Great ideas revisited. Techniques for evaluating training programs. Revisiting Kirkpatrick’s four level model. Train Dev 1996；50：54-59 12) Hasegawa J, Sekizawa A, Tanaka H, et al.：Current status of pregnancy-related maternal mortality in Japan: a report from the Maternal Death Exploratory Committee in Japan. BMJ Open 2016；6：e010304 5) Siassakos D, Fox R, Bristowe K, et al.：What makes maternity teams effective and safe? Lessons from a series of research on teamwork, leadership and team training. Acta Obstet Gynecol Scand 2013；92：1239-1243 7) Siassakos D, Bristowe K, Draycott TJ, et al.：Clinical efficiency in a simulated emergency and relationship to team behaviours: a multisite cross-sectional study. BJOG 2011；118：596-607 22) Kanda Y：Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant 2013；48：452-458 26) Ushida T, Kotani T, Imai K, et al.：Shock index and postpartum hemorrhage in vaginal deliveries: A multicenter retrospective study. Shock 2021；55：332-337 17) de Melo BCP, Van der Vleuten CPM, Muijtjens AMM, et al.：Effects of an in situ instructional design based postpartum hemorrhage simulation training on patient outcomes: an uncontrolled before-and-after study. J Matern Fetal Neonatal Med 2021；34：245-252 27) Ford JB, Roberts CL, Simpson JM, et al.：Increased postpartum hemorrhage rates in Australia. Int J Gynaecol Obstet 2007；98：237-243 6) Martijn L, Jacobs A, Amelink-Verburg M, et al.：Adverse outcomes in maternity care for women with a low risk profile in the Netherlands: a case series analysis. BMC Preg Childbirth 2013；13：219 10) Draycott TJ, Collins KJ, Crofts JF, et al.：Myths and realities of training in obstetric emergencies. Best Pract Res Clin Obstet Gynaecol 2015；29：1067-1076 1) Say L, Chou D, Gemmill A, et al.：Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014；2：e323 8) Egenberg S, Øian P, Bru LE, et al.：Can inter-professional simulation training influence the frequency of blood transfusions after birth? Acta Obstet Gynecol Scand 2015；94：316-323 23) Al-Kadri HM, Dahlawi H, Al Airan MA, et al.：Effect of education and clinical assessment on the accuracy of post-partum blood loss estimation. BMC Preg Childbirth 2014；14：110 24) Sohn CH, Kim WY, Kim SR, et al.：An increase in initial shock index is associated with the requirement for massive transfusion in emergency department patients with primary postpartum hemorrhage. Shock 2013；40：101-105 21) Kamiya K：Maternal and Child Health Statistics in Japan. Tokyo: Mothers’ and Children’s Health and Welfare Association, 2017 28) Joseph KS, Rouleau J, Kramer MS, et al.；Maternal Health Study Group of the Canadian Perinatal Surveillance System：Investigation of an increase in postpartum haemorrhage in Canada. BJOG 2007；114：751-759 9) Nathan HL, El Ayadi AE, Hezelgrave NL, et al.：Shock index: an effective predictor of outcome in postpartum haemorrhage? BJOG 2015；122：268-275 14) Main EK, McCain CL, Morton CH, et al.：Pregnancy-related mortality in California: causes, characteristics, and improvement opportunities. Obstet Gynecol 2015；125：938-947 13) Dillon SJ, Kleinmann W, Fomina Y, et al.：Does simulation improve clinical performance in management of postpartum hemorrhage? Am J Obstet Gynecol 2021；225：435.e1-435.e8 15) Committee Opinion No. 629：Clinical guidelines and standardization of practice to improve outcomes. Obstet Gynecol 2015；125：1027-1029 18) Draycott T：Not all training for obstetric emergencies is equal, or effective. BJOG 2017；124：651 4) Ladfors LV, Muraca GM, Zetterqvist J, et al.：Postpartum haemorrhage trends in Sweden using the Robson ten group classification system: a population-based cohort study. BJOG 2022；129：562-571 11) Bergh AM, Baloyi S, Pattinson RC：What is the impact of multi-professional emergency obstetric and neonatal care training? Best Pract Res Clin Obstet Gynaecol 2015；29：1028-1043 16) Fransen AF, van de Ven J, Schuit E, et al.：Simulation-based team training for multi-professional obstetric care teams to improve patient outcome: a multicentre, cluster randomised controlled trial. BJOG 2017；124：641-650 |
| References_xml | – reference: 13) Dillon SJ, Kleinmann W, Fomina Y, et al.：Does simulation improve clinical performance in management of postpartum hemorrhage? Am J Obstet Gynecol 2021；225：435.e1-435.e8 – reference: 1) Say L, Chou D, Gemmill A, et al.：Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014；2：e323 – reference: 8) Egenberg S, Øian P, Bru LE, et al.：Can inter-professional simulation training influence the frequency of blood transfusions after birth? Acta Obstet Gynecol Scand 2015；94：316-323 – reference: 28) Joseph KS, Rouleau J, Kramer MS, et al.；Maternal Health Study Group of the Canadian Perinatal Surveillance System：Investigation of an increase in postpartum haemorrhage in Canada. BJOG 2007；114：751-759 – reference: 22) Kanda Y：Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant 2013；48：452-458 – reference: 10) Draycott TJ, Collins KJ, Crofts JF, et al.：Myths and realities of training in obstetric emergencies. Best Pract Res Clin Obstet Gynaecol 2015；29：1067-1076 – reference: 15) Committee Opinion No. 629：Clinical guidelines and standardization of practice to improve outcomes. Obstet Gynecol 2015；125：1027-1029 – reference: 20) Hasegawa J, Katsuragi S, Tanaka H, et al.：Decline in maternal death due to obstetric haemorrhage between 2010 and 2017 in Japan. Sci Rep 2019；9：11026 – reference: 23) Al-Kadri HM, Dahlawi H, Al Airan MA, et al.：Effect of education and clinical assessment on the accuracy of post-partum blood loss estimation. BMC Preg Childbirth 2014；14：110 – reference: 11) Bergh AM, Baloyi S, Pattinson RC：What is the impact of multi-professional emergency obstetric and neonatal care training? Best Pract Res Clin Obstet Gynaecol 2015；29：1028-1043 – reference: 6) Martijn L, Jacobs A, Amelink-Verburg M, et al.：Adverse outcomes in maternity care for women with a low risk profile in the Netherlands: a case series analysis. BMC Preg Childbirth 2013；13：219 – reference: 4) Ladfors LV, Muraca GM, Zetterqvist J, et al.：Postpartum haemorrhage trends in Sweden using the Robson ten group classification system: a population-based cohort study. BJOG 2022；129：562-571 – reference: 18) Draycott T：Not all training for obstetric emergencies is equal, or effective. BJOG 2017；124：651 – reference: 3) Kramer MS, Berg C, Abenhaim H, et al.：Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstet Gynecol 2013；209：449.e1-449.e7 – reference: 5) Siassakos D, Fox R, Bristowe K, et al.：What makes maternity teams effective and safe? Lessons from a series of research on teamwork, leadership and team training. Acta Obstet Gynecol Scand 2013；92：1239-1243 – reference: 24) Sohn CH, Kim WY, Kim SR, et al.：An increase in initial shock index is associated with the requirement for massive transfusion in emergency department patients with primary postpartum hemorrhage. Shock 2013；40：101-105 – reference: 26) Ushida T, Kotani T, Imai K, et al.：Shock index and postpartum hemorrhage in vaginal deliveries: A multicenter retrospective study. Shock 2021；55：332-337 – reference: 19) Kirkpatrick D：Great ideas revisited. Techniques for evaluating training programs. Revisiting Kirkpatrick’s four level model. Train Dev 1996；50：54-59 – reference: 29) Rossen J, Okland I, Nilsen OB, et al.：Is there an increase of postpartum hemorrhage, and is severe hemorrhage associated with more frequent use of obstetric interventions? Acta Obstet Gynecol Scand 2010；89：1248-1255 – reference: 25) Nathan HL, Cottam K, Hezelgrave NL, et al.：Determination of normal ranges of shock index and other haemodynamic variables in the immediate postpartum period: a cohort study. PLOS ONE 2016；11：e0168535 – reference: 2) Knight M, Callaghan WM, Berg C, et al.：Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International postpartum hemorrhage Collaborative Group. BMC Preg Childbirth 2009；9：55 – reference: 27) Ford JB, Roberts CL, Simpson JM, et al.：Increased postpartum hemorrhage rates in Australia. Int J Gynaecol Obstet 2007；98：237-243 – reference: 21) Kamiya K：Maternal and Child Health Statistics in Japan. Tokyo: Mothers’ and Children’s Health and Welfare Association, 2017 – reference: 9) Nathan HL, El Ayadi AE, Hezelgrave NL, et al.：Shock index: an effective predictor of outcome in postpartum haemorrhage? BJOG 2015；122：268-275 – reference: 12) Hasegawa J, Sekizawa A, Tanaka H, et al.：Current status of pregnancy-related maternal mortality in Japan: a report from the Maternal Death Exploratory Committee in Japan. BMJ Open 2016；6：e010304 – reference: 17) de Melo BCP, Van der Vleuten CPM, Muijtjens AMM, et al.：Effects of an in situ instructional design based postpartum hemorrhage simulation training on patient outcomes: an uncontrolled before-and-after study. J Matern Fetal Neonatal Med 2021；34：245-252 – reference: 7) Siassakos D, Bristowe K, Draycott TJ, et al.：Clinical efficiency in a simulated emergency and relationship to team behaviours: a multisite cross-sectional study. BJOG 2011；118：596-607 – reference: 16) Fransen AF, van de Ven J, Schuit E, et al.：Simulation-based team training for multi-professional obstetric care teams to improve patient outcome: a multicentre, cluster randomised controlled trial. BJOG 2017；124：641-650 – reference: 14) Main EK, McCain CL, Morton CH, et al.：Pregnancy-related mortality in California: causes, characteristics, and improvement opportunities. Obstet Gynecol 2015；125：938-947 |
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| Snippet | 目的：鹿児島県では2018年から日本母体救命システム協議会ベーシックコース講習会の受講を推奨してきた．取り組み開始前後3年ずつの母体搬送症例の予後を比較しその効果を検討した．... |
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| SubjectTerms | Shock index シミュレーション教育 大量輸血 母体搬送 産後の異常出血 |
| Title | 日本母体救命システム協議会（J-CIMELS）講習会導入前後での産後異常出血搬送症例の比較検討：シミュレーション教育の普及は産後異常出血時の大量輸血を減少させるか |
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