A hands-on simulation based educational program was found to be a successful model to teach proven life saving techniques to advanced practice physicians in a LMIC. B-lynch suture was more easily adopted than the use of UBT. Overcoming the barriers for UBT at each site should be explored and addressed during the training process.

1. A Qualitative Study to Investigate Provider
Experiences after Introduction of B-Lynch Suture
and Uterine Balloon Tamponade in a LMIC-
Nicaragua
Elena Bryce MD1, Kay Daniels MD1
1 Dept of Obstetrics and Gynecology Stanford Health Care
BACKGROUND
Nicaragua is the second poorest
country in the Western hemisphere
with a maternal mortality of
95/100,000 births in comparison
with the USA rate of 17/100,000
births. The institution chosen for
this study was Hospital Escuela
Oscar Danilo Rosales Arguello
(HEODRA) a public teaching
hospital that performs >5000
deliveries a year. The training
program participants consisted of
28 residents and 21 faculty.
B lynch hemostatic suture and
uterine balloon tamponade (UBT)
are proven techniques for the
control of postpartum hemorrhage
(PPH) in high-resource areas.
Unfortunately, these techniques
have not consistently spread to
many LMIC where PPH is often the
leading cause of maternal mortality.
To overcome these barriers, a
simulation-based program aimed at
management of PPH has been
developed (GO MOMS). A
qualitative study was performed to
evaluate the impact of this program
by assessing provider experiences
with B-lynch and UBT in Nicaragua
METHODS
FINDINGS
CONCLUSIONS
A hands-on simulation based educational
program was found to be a successful
model to teach proven life saving
techniques to advanced practice
physicians in a LMIC.
B-lynch suture was more easily adopted
than the use of UBT. Overcoming the
barriers for UBT at each site should be
explored and addressed during the
training process.
A series of in-country simulation-based
education courses on the management of
PPH were provided to the residents and staff
of a major government teaching hospital in
León, Nicaragua from 2013-2015.This
course was the first exposure any of the
providers had to B-lynch or UBT.
In 2017 a follow-up study was performed
using semi-structured interviews. Subjects
were selected via a convenience sample of
residents and attendings who had performed
either B-Lynch or UBT or both. Subjects
signed an informed consent form prior to the
interview, and did not receive any
compensation for their participation.
Surveys were completed by 11 obstetric
providers (3 attendings and 8 residents)
Pooled responses indicated that 25 B-lynch
sutures had been performed since the start of
the program. 21/25 of these were successful,
while 4/25 were unsuccessful and
hysterectomy was performed. Lack of
appropriate suture was the main barrier to B-
lynch use.
UBT was performed only 8 times in the same
time period. Concerns about time needed to
gather the necessary material and delaying a
move to the operating room were the most
commonly cited barrier to UBT uptake.