Criterion 2.3-10: Managing major obstetric risks for maternal and fetal safety

What is Criterion 2.3-10?

Criterion 2.3-10, as defined in the sources, concerns the implementation by healthcare teams of measures to prevent major obstetric risks. This is a fundamental issue in the care of pregnant women, and it requires teams to be trained to quickly detect potential complications.

Why is Criterion 2.3-10 essential?

The prevention of major obstetric risks is a central issue to ensure the safety of patients and their newborns. This criterion is crucial because it aims to anticipate and limit the consequences of serious complications such as postpartum hemorrhage (PPH), pre-eclampsia, or dystocic deliveries. PPH, for example, is one of the top three causes of maternal deaths in France, defined by blood loss greater than 500 mL during childbirth or in the 24 hours following. Complications related to PPH can be severe, including hemorrhagic shock, complications related to transfusions or invasive surgical treatments, as well as long-term psychological sequelae.

How is Criterion 2.3-10 implemented?

The implementation of Criterion 2.3-10 is based on several organizational and technical pillars:

• Rapid detection and strict protocols: Teams apply protocols to anticipate risks, with enhanced prenatal monitoring for at-risk patients and effective management of obstetric emergencies.
• Emergency simulation and fluid communication: The implementation of emergency simulations and effective communication between the various stakeholders are essential to ensure optimal responsiveness.
• Mastery of professional skills: Teams must master the interpretation of fetal heart rate (FHR) and obstetric maneuvers through specific training.
• Emergency equipment and procedures: Life-saving emergency equipment, particularly in cases of immediate postpartum hemorrhage, must be checked and compliant, and life-saving emergency procedures must be accessible and known to professionals in delivery rooms.
• Specific protocols for emergencies: Each maternity unit is encouraged to draw up its own specific procedure for performing emergency caesarean sections, in consultation with the multidisciplinary team. This includes defining the roles of each professional, the minimum number of professionals required, call management, patient and equipment preparation, and the organization of anesthesia and newborn care.
• Testing and evaluation of protocols: The patient pathway must be tested as a team through simulation, and indicators are monitored to assess the conformity of indications and timelines of color codes.

Safeteam Training: P24 and P34 in service of Criterion 2.3-10

SafeTeam's P24 and P34 training courses are directly aligned with the objectives of Criterion 2.3-10, focusing on risk management, teamwork, and skills development for professionals.

P24 Training: Optimizing the management of the Red Code C-section

The P24 training course "Optimizing the management of red code cesarean sections" (P24) is designed for professionals who may be required to perform an emergency cesarean section. It aims to master the key steps of management and to structure and secure teamwork in performing an emergency cesarean section.

• Code Red represents an immediate life-threatening risk to the mother or child, requiring an urgent cesarean section with a decision/extraction time of less than 15 minutes. Indications for Code Red include fetal bradycardia (without recovery of the FHR within 10 minutes), failure of instrumental extraction with fetal heart rate abnormality (FHRA), suspected placental abruption, placenta previa with profuse maternal hemorrhage, suspected uterine rupture, and cord prolapse.
• It is important to note that maternal cardiac arrest is not classified as a Code Red, but as an extreme emergency requiring fetal extraction in less than 5 minutes to improve maternal prognosis, without preparation or anesthesia, performed on site. P24 training specifically covers how to respond to maternal cardiac arrest.
• The training uses immersive video simulation to retrace the multi-professional management of a patient, from the triggering of the red code to the performance of the cesarean section, followed by a video debriefing by field experts.

P34 Training: Management of Postpartum Hemorrhage

The P34 training course "Postpartum Hemorrhage" (P34) is intended for all healthcare personnel likely to manage a PPH. PPH is a major obstetric emergency that requires multidisciplinary teamwork.

• The objectives of the P34 training include the ability to recognize the warning signs of PPH, to identify the first management actions and to identify the role of each person within the team.
• Sources identify factors that aggravate PPH, such as primiparity, a history of PPH or cesarean section, induction, prolonged labor, episiotomy, general anesthesia, and multiple pregnancy. Knowledge of these factors is crucial for resource planning.
• The P34 training also uses an immersive video simulation retracing the multidisciplinary team management of an immediate PPH, from the alert to hemodynamic stabilization, with a video debriefing and an analysis of the situation by experts. The program includes mastering the key steps of management and identifying the steps for inserting an intrauterine tamponade balloon.

In summary, these courses enable healthcare professionals to acquire and strengthen the technical and organizational skills necessary to meet the requirements of Criterion 2.3-10, thereby ensuring optimal and safe management of obstetric emergencies.

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