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Advanced Life Support in Obstetrics (ALSO) and post-partum hemorrhage: a prospective intervention study in Tanzania


  • Conflict of interest
    The authors have stated explicitly that there are no conflicts of interest in connection with this article.

Bjarke Lund Sorensen, Department of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, Denmark. E-mail:


Objective. To evaluate the impact of Advanced Life Support in Obstetrics (ALSO) training on staff performance and the incidences of post-partum hemorrhage (PPH) at a regional hospital in Tanzania. Design. Prospective intervention study. Setting. A regional, referral hospital. Population. A total of 510 women delivered before and 505 after the intervention. Methods. All high- and mid-level providers involved in childbirth at the hospital attended a two-day ALSO provider course. Staff management was observed and post-partum bleeding assessed at all vaginal deliveries for seven weeks before and seven weeks after the training. Main Outcome Measures. PPH (blood loss ≥500ml), severe PPH (blood loss ≥1000ml) and staff performance to prevent, detect and manage PPH. Results. The incidence of PPH was significantly reduced from 32.9 to 18.2%[RR 0.55 (95%CI: 0.44–0.69)], severe PPH from 9.2 to 4.3%[RR 0.47 (95%CI: 0.29–0.77)]. The active management of the third stage of labor was also significantly improved. There was a significant decrease in episiotomies. By visual estimation, staff identified one in 25 of the PPH cases before the ALSO training and one in five after the training. A significantly higher proportion of women with PPH had continuous uterine massage, oxytocin infusion and bimanual compression of the uterus after the training. Conclusions. A two-day ALSO training course can significantly improve staff performance and reduce the incidence of PPH, at least as evaluated by short-term effects.