BACKGROUND Mothers in Africa are 50 times more likely to die after cesarean delivery (CD) than in high-income countries, largely due to hemorrhage. It is unclear whether countries across Africa are adequately equipped to prevent and treat postpartum hemorrhage (PPH) during and after CD. METHODS This was a cross-sectional survey of anesthesiologists and obstetricians across the African Perioperative Research Group (APORG). The primary objective was to determine readiness of the hospital system to implement the World Health Organization (WHO) recommendations for prevention and treatment of PPH during and after CD. The secondary objectives were to evaluate the availability of blood products, skilled human resources and establish available postoperative care after CD. Survey question format was close-ended or Likert scale, with options "always," "sometimes," or "never." RESULTS Responses were analyzed from 1 respondent from each of 140 hospitals from 29 low- and middle-income countries across Africa. Most respondents completed every data field on the case report form. Regarding WHO recommendations on prevention of PPH, oxytocin and misoprostol were available in 130/139 (93.5%) and 101/138 (73.2%) hospitals, respectively. There was limited access to heat-stable carbetocin (12/138 [8.7%]) and ergometrine (35/135, [25.9%]). Controlled cord traction for removal of placenta was always performed in 133/135 (98.5%) hospitals. Delayed cord clamping when neonatal resuscitation was not indicated, was not performed universally (86/134 [64.2%]). Regarding the treatment of PPH, crystalloids were always available in 133/139 (95.7%) hospitals, and the preferred initial resuscitation fluid (125/138 [90.6%]). Uterine massage was always performed in 117/139 (84.2%) hospitals. Tranexamic acid was always available in 97/139 (69.8%) hospitals. The availability of intrauterine balloon tamponade devices was limited. Most had immediate access to theater (126/139 [90.6%]). Responses concerning organizational recommendations showed that 113/136 (83.1%) hospitals had written protocols for the treatment of PPH. Protocols for patient referral and simulation training were limited. Most hospitals had access to emergency blood (102/139 [73.4%]). There was limited access to blood component therapy, with platelets available at 32/138 (23.2%), cryoprecipitate at 21/138 (15.2%) and fibrinogen at 11/139 (7.9%) hospitals. In-person specialist cover was reduced after-hours. CONCLUSIONS Important WHO-recommended measures to reduce hemorrhage during and after CD, are not currently available in many hospitals across Africa. It is likely that the lack of a combination of factors leads to failure to rescue mothers in Africa from postoperative complications. These findings should facilitate codesign of quality improvement initiatives to reduce hemorrhage related to CD.

中文翻译：

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评估非洲医院系统对剖宫产期间和之后出血的准备情况的横断面调查。


背景 非洲母亲在剖宫产 （CD） 后死亡的可能性是高收入国家的 50 倍，主要是由于出血。目前尚不清楚非洲各国是否有足够的能力来预防和治疗 CD 期间和之后的产后出血 （PPH）。方法 这是对非洲围手术期研究小组 （APORG） 的麻醉师和产科医生进行的横断面调查。主要目标是确定医院系统是否准备好实施世界卫生组织 （WHO） 关于在 CD 期间和之后预防和治疗 PPH 的建议。次要目标是评估血液制品的可用性、熟练的人力资源并确定 CD 后可用的术后护理。调查问题格式为封闭式或李克特量表，选项为“总是”、“有时”或“从不”。结果 分析了来自非洲 29 个低收入和中等收入国家 140 家医院中每家医院的 1 名受访者的回答。大多数受访者填写了案例报告表上的每个数据字段。关于 WHO 关于预防 PPH 的建议，催产素和米索前列醇分别在 130/139 （93.5%） 和 101/138 （73.2%） 医院提供。获得热稳定卡贝缩宫素 （12/138 [8.7%]） 和麦角新碱 （35/135， [25.9%]） 的机会有限。133/135 （98.5%） 医院始终进行受控脐带牵引以去除胎盘。当没有新生儿复苏指征时，延迟钳夹脐带并未普遍进行 （86/134 [64.2%]）。关于 PPH 的治疗，133/139 （95.7%） 的医院始终提供晶体液，首选的初始复苏液 （125/138 [90.6%]）。子宫按摩总是在 117/139 （84.2%） 医院进行。 氨甲环酸在 97/139 （69.8%） 医院中始终可用。宫内球囊填塞装置的可用性有限。大多数人可以立即进入剧院 （126/139 [90.6%]）。关于组织建议的回复显示，113/136 （83.1%） 医院制定了治疗 PPH 的书面方案。患者转诊和模拟培训的方案有限。大多数医院都能获得急诊血液 （102/139 [73.4%]）。获得血液成分治疗的机会有限，血小板可用率为 32/138 （23.2%），冷沉淀剂为 21/138 （15.2%），纤维蛋白原为 11/139 （7.9%）。下班后，面对面的专家覆盖减少了。结论 WHO 推荐的减少 CD 期间和之后出血的重要措施目前在非洲的许多医院不可用。缺乏多种因素的组合可能导致无法将非洲的母亲从术后并发症中拯救出来。这些发现应有助于质量改进计划的协同设计，以减少与 CD 相关的出血。