Advanced life support in obstetrics (ALSO) and post-partum hemorrhage: a prospective intervention study in Tanzania

Acta Obstet Gynecol Scand. 2011 Jun;90(6):609-14. doi: 10.1111/j.1600-0412.2011.01115.x. Epub 2011 Apr 15.


Objective: To evaluate the impact of Advanced Life Support in Obstetrics (ALSO) training on staff performance and the incidences of post-partum hemorrhage (PPH) at a regional hospital in Tanzania.

Design: Prospective intervention study.

Setting: A regional, referral hospital.

Population: A total of 510 women delivered before and 505 after the intervention.

Methods: All high- and mid-level providers involved in childbirth at the hospital attended a two-day ALSO provider course. Staff management was observed and post-partum bleeding assessed at all vaginal deliveries for seven weeks before and seven weeks after the training.

Main outcome measures: PPH (blood loss ≥500ml), severe PPH (blood loss ≥1000ml) and staff performance to prevent, detect and manage PPH.

Results: The incidence of PPH was significantly reduced from 32.9 to 18.2%[RR 0.55 (95%CI: 0.44-0.69)], severe PPH from 9.2 to 4.3%[RR 0.47 (95%CI: 0.29-0.77)]. The active management of the third stage of labor was also significantly improved. There was a significant decrease in episiotomies. By visual estimation, staff identified one in 25 of the PPH cases before the ALSO training and one in five after the training. A significantly higher proportion of women with PPH had continuous uterine massage, oxytocin infusion and bimanual compression of the uterus after the training.

Conclusions: A two-day ALSO training course can significantly improve staff performance and reduce the incidence of PPH, at least as evaluated by short-term effects.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Cardiopulmonary Resuscitation*
  • Episiotomy / statistics & numerical data
  • Female
  • Hospitals, District / statistics & numerical data
  • Humans
  • Incidence
  • Infant, Newborn
  • Inservice Training*
  • Labor, Obstetric*
  • Life Support Care / methods*
  • Massage
  • Medical Staff, Hospital / education*
  • Nursing Staff, Hospital / education*
  • Oxytocin / administration & dosage
  • Postpartum Hemorrhage / epidemiology*
  • Postpartum Hemorrhage / prevention & control*
  • Pregnancy
  • Prospective Studies
  • Tanzania / epidemiology
  • Uterus


  • Oxytocin