Pronto Low-Tech Obstetric Simulation and Team Training in Mexico Improves Patient Outcomes, and Evidence-Based Care at Birth

INTRODUCTION: Emergency obstetric simulation and team training can improve patient outcomes. However, in limited-resource countries, cost limits access and few studies measure effect. METHODS: Cluster-randomized trial including 24 community hospitals matched in 12 pairs in three Mexican states. From August 2010 to January 2012, 436 health care providers at 12 intervention hospitals received PRONTO two-step training (Module I [16 hours], Module II [8 hours] 3 months later) (www.prontointernational.org). PRONTO puts interprofessional teams through skill stations, activities, and eight highly realistic simulations using the PartoPants birth simulator. Data collection for all 24 hospitals were: baseline vital statistics, birth observation, and chart review at baseline and 4, 8, and 12 months postintervention. RESULTS: A total of 58,337 deliveries occurred and 641 births were observed. Difference-in-differences effect estimations showed a 44% decrease in perinatal mortality rates at 8 months postintervention (95% confidence interval [CI] –87% to –36%: P=.010) in intervention hospitals and a decrease in eclampsia by 68% at 12 months (95% CI –91% to 9%; P=.069). There was a 23-percentage points increase in the first step of active management of the third stage of labor at 8 months (95% CI –2% to 48%; P=.08) and a 31% percentage points decrease in postpartum uterine sweeping at 8 months (95% CI –58% to –4%; P=.02). CONCLUSIONS: Highly realistic, low-tech simulation can improve outcomes but may require refresher training to maintain effect. PRONTO training in Mexico reduced perinatal mortality by almost seven deaths per 1,000 births after adjusting for baseline differences. Making simulation and team training accessible globally has the potential to save the lives of mothers and neonates.