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.