Obstetrical Simulator
Curriculum
Sarah Price, MD
Amanda Pauley, MD
MU Dept. of Obstetrics and
Gynecology
Abstract/Purpose
The infrequent and high-stakes nature of obstetric
emergencies requires physicians to respond quickly and
proficiently to a complex and high-stress situation, a
situation they have likely had little opportunity to
experience. We planned to create a realistic simulation
to prepare physicians at our institution to manage these
situations. Shoulder dystocia, vaginal breech extraction,
postpartum hemorrhage, and forceps assisted vaginal
delivery can all be obstetrical emergencies that require
immediate recognition and a well-coordinated response.
Simulation education provides an opportunity to learn
and master simple as well as complex technical skills
Methods
A curriculum was written for each of four potential
obstetrical emergencies including vaginal breech
delivery, shoulder dystocia, postpartum hemorrhage,
and forceps assisted vaginal delivery. Each emergency
has a sample case presentation as well as a checklist of
knowledge and skills that physicians are expected to
know when they are on the simulator.
Vaginal Breech Delivery
32yo G3P2002 at 38 0/7
weeks gestation presents
to triage complaining of
contractions. Her
pregnancy has been
uncomplicated. Her two
previous deliveries were
vaginal deliveries without
complication. She is placed
on the monitor and the
fetal heart tracing is
140s/moderate
Shoulder Dystocia
-H Call for help
-E Evaluate for episotomy
-L Legs (McRoberts Maneuver)
-P Suprapubic pressure to disengage the anterior
shoulder
-E Enter internal rotation maneuvers (Rubin, Wood
screw)
-R Remove posterior arm
-R Roll patient over
Postpartum Hemorrhage
Call for nursing help
Ask for a second iv- at least 18 gauge
Assess vital signs including heart rate, blood pressure
and pulse oximetry at least every 5 minutes
Start i.v. crystalloid bolus
Assess for atony
Assess for lacerations
Assess for retained products
Forceps Assisted Vaginal
Delivery
Indications for Operative Vaginal Delivery
No indication for operative vaginal delivery is
absolute. The following indications apply
when the fetal head is engaged and the cervix
is fully dilated.
•
•
Prolonged second stage:
Nulliparous women: lack of continuing
progress for 3 hours with regional
anesthesia, or 2 hours without regional
anesthesia
Multiparous women: lack of continuing
progress for 2 hours with regional
anesthesia, or 1 hour without regional
anesthesia
Suspicion of immediate or potential fetal
compromise.
•
Shortening of the second stage for maternal
benefit.
•
Studies have shown that
learning retention rates are
significantly higher with hands
on training as in simulation
laboratories.
Future Plans
Our plans are to continue to educate our residents
regarding these obstetrical emergencies, but also to involve
our nursing and anesthesia staff. Studies have shown that
teamwork reduces clinical errors and improves patient
outcomes. Therefore, we will conduct drills with our
simulator to assist in team training.