title: The impact of Advanced Life Support in Obstetrics (ALSO) training in low-resource countries.
abstract: OBJECTIVE
  To examine the effects of the Advanced Life Support in Obstetrics (ALSO) program on maternal outcomes in four low-income countries.
  
  
  METHODS
  Data were obtained from single-center, longitudinal cohort studies in Colombia, Guatemala, and Honduras, and from an uncontrolled prospective trial in Tanzania.
  
  
  RESULTS
  In Colombia, maternal morbidity and the number of near misses increased after ALSO training, but maternal mortality decreased. In Guatemala, sustained reductions in overall maternal mortality and mortality from postpartum hemorrhage (PPH) were recorded after ALSO implementation. In Honduras, there was a significant decrease in episiotomy rates, and increases in active management of the third stage of labor (AMTSL), vacuum-assisted delivery, and reported comfort managing obstetric emergencies. In Tanzania, the frequency of PPH and severe PPH decreased after training, while management improved.
  
  
  CONCLUSIONS
  In low-income countries, ALSO training was associated with decreased in-hospital maternal mortality, episiotomy use, and PPH. AMTSL and vacuum-assisted vaginal delivery increased in frequency after ALSO training.
authors: Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. Electronic address: lee.dresang@fammed.wisc.edu.
authors: Lee T
authors: LT
authors: Dresang
authors: Department of Family Medicine, Universidad San Carlos de Occidente, Quetzaltenando, Guatemala.
authors: María Mercedes Ancheta
authors: MM
authors: González
authors: Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors: John
authors: J
authors: Beasley
authors: Department of Obstetrics and Gynecology, Hospital Escuela, Tegucigalpa, Honduras.
authors: Maura Carolina
authors: MC
authors: Bustillo
authors: Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors: Jim
authors: J
authors: Damos
authors: Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
authors: Mark
authors: M
authors: Deutchman
authors: Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors: Ann
authors: A
authors: Evensen
authors: Department of Family Medicine, Universidad San Carlos de Occidente, Quetzaltenando, Guatemala.
authors: Norma González
authors: NG
authors: de Ancheta
authors: Department of Obstetric Medicine, Intensive Care and Obstetric Investigation Group, Sociedad Colombiana de Anestesiologia y Reanimación, Cartagena, Colombia.
authors: José A
authors: JA
authors: Rojas-Suarez
authors: Department of Pediatrics, Wayne State University, Detroit, MI, USA.
authors: Jonathan
authors: J
authors: Schwartz
authors: Department of Obstetrics and Gynecology, Centre for Innovative Medical Technology, Department of Clinical Research, Odense University Hospital and University of Southern Denmark, Odense, Denmark.
authors: Bjarke L
authors: BL
authors: Sorensen
authors: American Academy of Family Physicians, Leawood, KS, USA.
authors: Diana
authors: D
authors: Winslow
authors: Department of Family and Community Medicine, Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM, USA.
authors: Lawrence
authors: L
authors: Leeman
mesh_terms: D000328:Adult; D003105:Colombia; D036861:Delivery, Obstetric / Q000639:trends; D003906:Developing Countries; D005260:Female; D006166:Guatemala; D006721:Honduras; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008020:Life Support Care / Q000379:methods*; D008137:Longitudinal Studies; D008428:Maternal Mortality / Q000639:trends; D000067491:Near Miss, Healthcare / Q000639:trends; D009774:Obstetrics / Q000193:education*; D006473:Postpartum Hemorrhage / Q000401:mortality; D011247:Pregnancy; D015397:Program Evaluation / Q000706:statistics & numerical data*; D011446:Prospective Studies; D013636:Tanzania
keywords: Delivery; Education; Emergency treatment; Family-centered perinatal care; Obstetrics; Outcomes; Technology assessment