title: Improving maternal health and safety through adherence to postpartum hemorrhage protocol in Latin America.
abstract: OBJECTIVE
  To determine provider compliance with protocols for the prevention of postpartum hemorrhage and provider characteristics associated with adherence and non-adherence.
  
  
  METHODS
  A multicenter descriptive study was conducted involving 78 direct observations of provider-implemented protocols and 52 interviews with Peruvian maternal healthcare providers at 4 Peruvian clinical sites representing the local, regional, and national levels of care. Parturient participants planning a normal vaginal delivery were 17-49 years of age and 34-42 weeks pregnant. Primary outcomes were compared using χ2 testing, while quantitative survey data were evaluated using means, standard deviations, and Student t test or analysis of variance for statistical significance.
  
  
  RESULTS
  There were 3 significant differences between the national, regional, and local levels of care: adherence to all 3 interventions (P<0.001); professional experience (P<0.04); and retention of healthcare providers (P<0.001). There were no differences in provider training (P<0.097), and the retention of experienced healthcare providers was not associated with greater adherence to protocols. There were no significant differences in parturient characteristics.
  
  
  CONCLUSIONS
  Individual characteristics and institutional beliefs may have more influence than experience or training on adherence to protocols for prevention of postpartum hemorrhage; addressing these biases may improve patient safety in Peru and throughout Latin America.
authors.affiliation: Yale Physician Associate Program, Yale University School of Medicine, New Haven, USA. Electronic address: ben.olmedo@gmail.com.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Olmedo
authors.affiliation: US Agency for International Development, USAID|Peru|Quality Health Care, Lima, Peru.
authors.forename: Eva
authors.initials: E
authors.lastname: Miranda
authors.affiliation: US Agency for International Development, USAID|Peru|Quality Health Care, Lima, Peru.
authors.forename: Oscar
authors.initials: O
authors.lastname: Cordon
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, USA.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Pettker
authors.affiliation: Department of Obstetrics and Gynecology, Ohio State University College of Medicine, Columbus, USA.
authors.forename: Edmund F
authors.initials: EF
authors.lastname: Funai
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003151:Community Health Centers / Q000592:standards; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007318:Inservice Training; D008875:Middle Aged; D009774:Obstetrics / Q000193:education; D015279:Organizational Culture; D061214:Patient Safety; D010563:Personnel Turnover; D010568:Peru; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011787:Quality of Health Care; D063728:Secondary Care Centers / Q000592:standards; D062606:Tertiary Care Centers / Q000592:standards; D055815:Young Adult
keywords: Maternal health; Patient safety; Peru; Postpartum hemorrhage prevention; Protocol adherence