# Prehospital Management of Postpartum Hemorrhage—A National, Cross-Sectional Study in Norway

## TL;DR

This study assesses how well prehospital personnel in Norway are trained to handle postpartum hemorrhage and finds a significant need for more education and training.

## Contribution

The study provides new insights into the current state of PPH management training and knowledge among prehospital personnel in Norway.

## Key findings

- Most prehospital personnel reported needing more education and training in PPH management.
- Only a small percentage had used external aortic compression or encountered PPH cases.
- Bimanual uterine compression was the most commonly used intervention.

## Abstract

Introduction: Postpartum hemorrhage (PPH) is a critical birth complication, and is stated by the World Health Organization (WHO) as among the five most frequent causes of death during pregnancy. External aortic compression (EAC) is recommended by the WHO as an intervention to achieve temporary bleeding control. An increasing number of births outside hospital underlines the importance of competence in handling potential birth complications, such as PPH. The aim of this study was to assess prehospital personnel’s education, training, knowledge, and experiences regarding PPH and EAC across Norway. Methods: Prehospital personnel were invited to respond to a questionnaire through social media. Questions included those on education, training, knowledge, and experience regarding PPH and EAC. The Statistical Package for the Social Sciences (SPSS) version 28 was used to analyze the data, using descriptive statistics. Results: Over a two-month period, 211 prehospital personnel responded to the questionnaire, of whom 55.5% were male. The respondents had an average of 10.3 years of prehospital experience. About half of the respondents had received education (48.6%) and training (62.4%) in PPH management. Still, 95.7 percent reported a need for more education and training. On knowledge questions, only half of the responses were correct (43.7% to 60.5%). Only 21 percent of the respondents had experienced patients with PPH, and of these only 3.8 percent had used EAC. Bimanual uterine compression was the most frequent intervention used (62.5%) across hospital trusts. Conclusions: Even if prehospital personnel receive education and training in the management of PPH and EAC, almost all report needing more. The results indicate a national variation, which may be discussed as to whether it is appropriate.