Data collection
The primary outcome was to investigate the efficacy of the programme by comparing the change in the obstetrical providers’ behaviours and the maternal outcome before and after the providers attended the programme. The data were compared before (period 1: 2015–2017) and after (period 2: 2018–2020) introducing the J-MELS.
All data were collected from the patients’ medical records. The baseline characteristics of all patients, including maternal age, body mass index at delivery, parity, mode of conception, and mode of delivery, were collected. To assess providers’ behavioural changes at the referring hospitals, the existence of an SI record, oxygen administration, the use of more than two IV routes with lines ≥20 gauge, amount of blood loss, and time from delivery to maternal transfer were evaluated. To assess the maternal outcome, the maternal SI, disturbance of consciousness, body temperature, haemoglobin (Hb) level, and platelet (Plt) counts on arrival were recorded. In addition, massive transfusion (packed red blood cell transfusion ≥10 units), hysterectomy, interventional radiology (IVR), and maternal death were evaluated. If one provider (obstetrician, midwife, or nurse) attended the programme at the time of transfer, the institution of the provider was also considered to be part of the programme.