A total of 87 prehospital healthcare personnel (34.8 percent) responded to the questionnaire. Table 2 gives an overview of respondents’ gender, age, educational background and years of experience.
In this study, the Cronbach’s alpha was 0.89 on the PPHSE scale, and 0.96 on the PPHCE, which is assumed excellent.
Responses to the developed questionnaire
Knowledge about PPH
On the question “How much is normal hemorrhage during birth, and when is it defined as postpartum hemorrhage?” most of the respondents assumed a hemorrhage of up to 500 ml as normal per-partum. Hemorrhage above 500 ml was interpreted as postpartum hemorrhage by 37 of the respondents. Other answers were ‘above 1 litre’ (n=17), ‘2 litres’ (n=3), ‘1.5 litre’ (n=1) and ‘3-4 litres’ (n=1). The rest were undecided.
Regarding the question “How do you estimate the amount of hemorrhage during/after birth?” 39 respondents found this ‘difficult’. A total of 18 respondents reported to assess the sheets or diapers, how often they needed to be changed, or even to weigh them. In addition, 21 of the respondents reported to assess the patients´ vital parameters or level of consciousness.
Knowledge about interventions
On the question “Which interventions should be initiated in postpartum hemorrhage?”, the responses varied. Reported from most to least frequent response; uterus massage (n=29), fluid resuscitation (n=22), put the baby to the breast (n=14), abdominal massage (n=10), establish intravenous access (n=9), add pressure on the abdominal aorta (n=9), elevate legs (n=9), quick transport to hospital (n=8), oxygen treatment (n=7), put pressure to the abdomen (n=5), shock-treatment (n=5), put the fist into the woman and add pressure from the inside (n=5), areola massage (n=4), hemorrhage control (n=4), and oxytocin (n=3). Other suggestions were ‘add pressure on the inguinal aorta’, ‘analgesia’, ‘tranexamacid’, ‘comfort the mother’, ‘compression’, ‘early warning to the hospital’. The questionnaire also included the question “When you observe a life threatening hemorrhage, what do you do first?» Answers here were similar to those above regarding interventions.
Other “Clinical situations than postpartum hemorrhage where manual aortic compression can be lifesaving» reported were ‘hemorrhage in the lower extremities” (n=7), ‘abdominal aorta aneurism’ (AAA) (n=7), ‘other vaginal hemorrhage’ (n=6), amputations (n=4), other causes of massive hemorrhage such as extrauterine pregnancy (n=2), and open wounds (n=2).
Whether the ambulance had any drugs for use in situations of postpartum hemorrhage, most respondents reported ‘no’ (82.8 percent), while 11.5 percent were undecided, and 5.7 percent of the respondents reported ‘yes’. Drug reported accessible was oxytocin, and side-effects of this drug was reported to be ‘high blood-pressure’ (n=1), and ‘nausea and vomiting’ (n=1).
To the question “When is manual aortic compression (using a fist on aorta) appropriate?”, responses were ‘in massive hemorrhage’ (n=32), ‘in PPH’ (n=13), ‘in life-threatening hemorrhage’ (n=5), ‘when the child is delivered’(n=2), ‘when uterus massage does not have an effect’ (n=2), and ‘AAA’(n=1) (non-response, n=32).
Contra-indications to AC reported were ‘limited hemorrhage’ (n=28), ‘child not delivered’ (n=6), ‘pain’(n=1), and ‘patient awake’ (n=1) (non-response, n=51).
Knowledge about performance of AC
When asked «How would you provide manual aortic compression?» 12 of the respondents reported ‘establish pulse in arteria femoralis, add pressure above the uterus until absence of pulse’. And 20 respondents reported to ‘add pressure on the abdomen’, but location of pressure varied from ‘under the diaphragm’, ’umbilical area’, or ‘in the middle’. Ten respondents answered ‘add pressure on the aorta’, four respondents reported ‘add pressure both from the inside and outside’, and three ‘add vaginal pressure’.
When asked what the purpose of AC is, 71 respondents reported ‘to stop the hemorrhage’. On the question “How do you assess whether the maneuver is conducted correct?”, 35 responded ‘when the hemorrhage stops’, and 18 responded ‘when the pulse in arteria femoralis is absent’. Regarding considerations during drug administration and ongoing AC, five respondents reported ‘side-effects’, and one reported ‘that drugs are not transported beyond the location of pressure’. A total of 82.8 percent of the respondents reported ‘no’, 11.5 percent reported ‘undecided’ and 5.7 percent reported ‘yes’, to the question about whether there are potential complications related to AC. Suggested complications were ‘damage due to ischemia’ (n=4), ‘reduced blood pressure’(n=3), ‘damage to inner organs’(n=1), and ‘pain’ (n=1).
No relation between educational background and level of knowledge could be identified.
Need for education and/or training
When asked “Do you want more education in handling postpartum hemorrhage?”, 96.6 percent responded ‘yes’, 1.1 percent responded ‘no’, and 2.3 percent responded ‘undecided’.
Among the respondents, 97.7 percent answered ‘yes’ that they want more training/simulation in handling postpartum hemorrhage.
Participants that responded ‘no’ or ‘undecided’ that they needed more education or training were all assistants or ambulance workers.
Experience
Prehospital personnel’s experience with PPH and AC is shown in table 3.
Reasons for not using AC were ‘lack of education’ (74.7 percent), ‘lack of training’ (10.3 percent), ‘feel unsecure on the procedure’ (10.3 percent), and ‘difficult to cause the patient pain’ (4.6 percent) (fixed response alternatives).
Self-efficacy in PPH