OP-109 : ALSO Honduras

Lee Dresang, Carolina Bustillo, Jonathan Schwartz, United States
To demonstrate the impact of the Advanced Life Support in Obstetrics (ALSO®) course in a developing country.

An evaluation tool was administered immediately prior to, immediately after, 6 months after and 12 months after the first ALSO® courses taught in Honduras in 2005. In addition, episiotomy, caesarean, maternal mortality, post-partum haemorrhage, transfusion and hysterectomy rates were obtained before the course and tracked prospectively for a year after the course.

The evaluation tool implemented in Honduras demonstrates that ALSO® significantly 1) improves provider comfort level in managing obstetrical emergencies, 2) improves perceived technical and management skills and perceived infant and maternal outcomes related to these technical and management skills, and 3) changes practice patterns, including decreased use of episiotomy and increased active management of the third stage of labour, both of which are known to improve maternal and infant outcomes. From pre-course to immediately post-course, respondents had a statistically significant increase in reported comfort managing 9 of 13 obstetric emergencies; this persisted through the 12 month follow-up. The episiotomy rate dropped markedly within two month of the ALSO® course from above 40 percent to below 20 percent. After ALSO®, active management of the third stage of labour was established as the norm: Pitocin was used with 90 percent of deliveries and traction on the cord was employed with 96 percent.

ALSO® is powerful tool in addressing Millennium Development Goal #5. Broader implementation and evaluation are indicated. (Note: Presenters teaching ALSO WONCA May 21-24; only available May 19 + 20)