Impact of an educational intervention on patient safety culture among gynecology-obstetrics' healthcare professionals.

BACKGROUND: In recent years, patient safety has begun to receive particular attention and has become a priority all over the world. Patient Safety Culture (PSC) is widely recognized as a key tenet that must be improved in order to enhance patient safety and prevent adverse events. However, in gynecology and obstetrics, despite the criticality of the environment, few studies have focused on improving PSC in these units. This study aimed at assessing the effectiveness of an educational program to improve PSC among health professionals working in the obstetric unit of a Tunisian university hospital. METHODS: We conducted a quasi-experimental study in the obstetric unit of a university hospital in Sousse (Tunisia). All the obstetric unit's professionals were invited to take part in the study (n = 95). The intervention consisted of an educational intervention with workshops and self-learning documents on patient safety and quality of care. The study instrument was the French validated version of the Hospital Survey on Patient Safety Culture. Normality of the data was checked using Kolmogorov-Smirnov test. The comparison of dimensions' scores before and after the intervention was carried out by the chi2 test. The significance level was set at 0.05. RESULTS: In total, 73 participants gave survey feedback in pre-test and 68 in post-test (response rates of 76.8% and 71.6, respectively). Eight dimensions improved significantly between pre- and post-tests. These dimensions were D2 "Frequency of adverse events reported" (from 30.1 to 65.6%, p < 0.001), D3 "Supervisor/Manager expectations and actions promoting patient safety" (from 38.0 to 76.8%, p < 0.001), D4 "Continuous improvement and organizational learning" (from 37.5 to 41.0%, p < 0.01), D5 "Teamwork within units" (from 58.2 to 79.7%, p < 0.01), D6 "Communication openness" (from 40.6 to 70.6%, p < 0.001), and D7 "Non-punitive response to error" (from 21.1 to 42.7%, p < 0.01), D9 "Management support for patient safety" (from 26.4 to 72.8%, p < 0.001), and D10 "Teamwork across units" (from 31.4 to 76.2%, p < 0.001). CONCLUSIONS: Educational intervention, including workshops and self-learning as pedagogical tools can improve PSC. The sustainability of the improvements made depends on the collaboration of all personnel to create and promote a culture of safety. Staff commitment at all levels remains the cornerstone of any continuous improvement in the area of patient safety.

Complete non-puerperal uterine inversion caused by uterine hemangioma: about a case report.

Uterine inversion is a rare postpartum complication. It is a rare condition in which the internal surface of the uterus protrudes through the vagina. Non-puerperal uterine inversion (NPUI) is extremely rare. In most instances, it is linked to uterine tumors. Among these tumors, leiomyoma is the most frequent cause reported in data. This condition may not be noticed until time of surgery. Malignancy is suspected in most cases. Nevertheless, uterine inversion can be diagnosed preoperatively using radiology. Difficulties in diagnosing NPUI makes this clinical case a challenge in gynaecology and not commonly reported in literature. We report our experience in the diagnosis and treatment of a complete non-puerperal uterine inversion associated with uterine angioleiomyoma. The patient's age was 44, gravida 2 para 1 presented with intermittent vaginal bleeding for four months and an acute abdominal cramping pain. On examination, a large mass lesion was observed which occupies the vaginal cavity and the contour of the uterine cervix could not be reached. Biopsies and Immunohistochemistry matched with an angioleiomyoma. She underwent a transvaginal surgical reposition technique: Spinelli's. It is important to diagnose accurate non-puerperal uterine inversion. Surgery provides good prognosis and it is necessary. We report a case of NPUI caused by angioleiomyoma. Nevertheless, malignancy must be eliminated in first place.

The effect of placental removal method at cesarean delivery on perioperative hemorrhage: a randomized clinical trial ISRCTN 49779257.

OBJECTIVES: To evaluate whether the method of placental removal during cesarean section has an impact on perioperative hemorrhage and maternal infectious morbidity. STUDY DESIGN: Three hundred and two patients admitted for abdominal delivery were recruited in a prospective randomized clinical intention-to-treat trial. Participants were assigned to have their placenta removed either manually or spontaneously. The drop in hematocrit was the primary outcome; postpartum maternal infectious morbidity was also assessed. RESULTS: Two patients were excluded for incomplete data. One-hundred-fifty-one were randomized to the manual removal group and 149 to the spontaneous group. The demographic characteristics of the two populations were similar. The mean drop (%) in the manual removal group was greater than in the spontaneous group (5.57+/-3.86 and 2.65+/-2.67, respectively; P<0.01). the incidence of postpartum infectious morbidity was also significantly greater in the manual group (RR 15.8, 95% CI 2.19-117.5). CONCLUSION: Routine manual removal of placenta at cesarean section significantly increases perioperative blood loss and postpartum maternal infectious morbidity.