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Mappa I, Masturzo B, Carbone IF, Kiener A, Maruotti GM, Pintucci A, Suprani A, Visentin S, Ghi T, Rizzo G. A national survey on current practice of ultrasound in labor ward. J Perinat Med 2024; 52:509-514. [PMID: 38651816 DOI: 10.1515/jpm-2024-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/10/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVES Use of ultrasonography has been suggested as an accurate adjunct to clinical evaluation of fetal position and station during labor. There are no available reports concerning its actual use in delivery wards. The aim of this survey was to evaluate the current practice regarding the use of ultrasonography during labor. METHODS A questionnaire was sent to members of the Italian Society of Ultrasound in Obstetrics and Gynecology employed in delivery wards. The qFeuestionnaire was made up of 22 questions evaluating participant characteristics and the current use of ultrasound in labor in their hospital of employment. The answers were grouped according to participant characteristics. RESULTS A total of 200 participants replied. Ultrasound was considered useful before an operative vaginal delivery by 59.6 % of respondents, while 51.8 and 52.5 % considered it useful in the management of prolonged first and second stages of labor, respectively. The major indication for ultrasound use during labor was the assessment of fetal occiput position. The major difficulties in its application were the perceived lack of training and the complexity of the ultrasound equipment use. Participants that reported fewer difficulties were those employed in hospitals with a higher number of deliveries or having delivery units with more years of experience using ultrasound in labor, or those who had attended specific training courses. CONCLUSIONS The results indicate that, despite the reported evidence of a higher accuracy of ultrasound compared to clinical evaluation in assessing fetal position and station, its use is still limited, even amongst maternal-fetal medicine practitioners specialized in ultrasonography.
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Affiliation(s)
- Ilenia Mappa
- Department of Obstetrics and Gynecology, 9318 Fondazione Policlinico di Tor Vergata, University of Rome Tor Vergata , Rome, Italy
| | - Bianca Masturzo
- Department of Obstetrics and Gynecology, Ospedale di Biella, Biella, Italy
| | - Ilma Floriana Carbone
- Unit of Obstetrics, Department of Woman, Child and Neonate, 9339 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan, Italy
| | - Ariane Kiener
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, 9370 University of Parma , Parma, Italy
| | | | - Armando Pintucci
- Department of Obstetrics and Gynaecology, ASST di Monza, Desio, Italy
| | - Alice Suprani
- Department of Women's and Children's Health, Forlì-Cesena, Cesena, Italy
| | - Silvia Visentin
- Department of Women's and Children's Health, 9308 University of Padua , Padova, Italy
| | - Tullio Ghi
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, 9370 University of Parma , Parma, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, 9318 Fondazione Policlinico di Tor Vergata, University of Rome Tor Vergata , Rome, Italy
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Germano C, Girlando F, Carosso AR, Messina A, Parpinel G, Leo L, Attini R, Revelli A, Masturzo B. Uterine Balloon Tamponade under Ultrasound Guidance in Women with Postpartum Hemorrhage: A Retrospective Cohort Study. J Clin Med 2024; 13:2632. [PMID: 38731162 PMCID: PMC11084657 DOI: 10.3390/jcm13092632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/15/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Postpartum hemorrhage (PPH) represents one of the principal causes of maternal mortality and morbidity worldwide. Uterine balloon tamponade (UBT) is recommended for the treatment of postpartum hemorrhage due to uterine atony in women who do not respond to pharmacological first-line treatment. The success of UBT in bleeding control is related to the correct positioning of the device, since incorrect insertion can be associated with ineffectiveness and requires time-consuming repositioning maneuvers, with a further increase in blood loss. The use of ultrasound (US) during UBT may increase the success rate by preventing wrong positioning. This study aims to demonstrate the role of US guidance during UBT and to assess whether US guidance can ease positioning and reduce insertion times, preventing additional repositioning maneuvers, in comparison with a US check carried out after balloon insertion. Methods: This was a retrospective study including 370 women who underwent vaginal delivery, had PPH caused by uterine atony and required UBT at Sant'Anna Hospital from 2015 to 2019. The exclusion criteria were an abnormal placental site, vaginal or cervical trauma, coagulation defects, uterine anomalies, previous postpartum hemorrhage and previous caesarean section. Included subjects were divided into two groups: the US-guided group (n = 200) underwent Bakri balloon positioning under US guidance, and the non-guided group (n = 170) received a US check only after balloon insertion. The primary outcome was the success rate of the procedure, expressed as the percentage of cases with bleeding control without the need for balloon repositioning; the secondary outcomes were the length of the procedure and some parameters related to blood loss. Results: The success rate was 99% for the US-guided group vs. 86% for the non-guided group. None of the patients required hysterectomy. In the US-guided group with respect to the non-guided group, we observed a significant reduction in blood loss (1100 ± 450 vs. 1500 ± 600 mL; p < 0.001), Δhemoglobin level (1.8 ± 1.1 vs. 2.7 ± 2.0 g/dL, p < 0.001) and time required for the procedure (8 vs. 13 min, p < 0.001). Conclusions: Our data suggest that the use of US guidance for placement of UBT was associated with reduced need for balloon repositioning, lower blood loss, and faster resolution of postpartum hemorrhage.
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Affiliation(s)
- Chiara Germano
- Department of Obstetrics and Gynecology, Nuovo Ospedale degli Infermi, 13875 Biella, Italy; (G.P.); (R.A.); (B.M.)
| | - Flavia Girlando
- SCDU2, Department of Surgical Sciences, Sant’Anna Hospital, University of Turin, 10126 Turin, Italy; (F.G.); (A.R.C.); (A.M.); (A.R.)
| | - Andrea Roberto Carosso
- SCDU2, Department of Surgical Sciences, Sant’Anna Hospital, University of Turin, 10126 Turin, Italy; (F.G.); (A.R.C.); (A.M.); (A.R.)
| | - Alessandro Messina
- SCDU2, Department of Surgical Sciences, Sant’Anna Hospital, University of Turin, 10126 Turin, Italy; (F.G.); (A.R.C.); (A.M.); (A.R.)
| | - Giulia Parpinel
- Department of Obstetrics and Gynecology, Nuovo Ospedale degli Infermi, 13875 Biella, Italy; (G.P.); (R.A.); (B.M.)
| | - Livio Leo
- Department of Obstetrics and Gynecology, Beauregard Hospital, 11100 Aosta, Italy;
| | - Rossella Attini
- Department of Obstetrics and Gynecology, Nuovo Ospedale degli Infermi, 13875 Biella, Italy; (G.P.); (R.A.); (B.M.)
| | - Alberto Revelli
- SCDU2, Department of Surgical Sciences, Sant’Anna Hospital, University of Turin, 10126 Turin, Italy; (F.G.); (A.R.C.); (A.M.); (A.R.)
| | - Bianca Masturzo
- Department of Obstetrics and Gynecology, Nuovo Ospedale degli Infermi, 13875 Biella, Italy; (G.P.); (R.A.); (B.M.)
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Romero R, Sabo Romero V, Kalache KD, Stone J. Parturition at term: induction, second and third stages of labor, and optimal management of life-threatening complications-hemorrhage, infection, and uterine rupture. Am J Obstet Gynecol 2024; 230:S653-S661. [PMID: 38462251 DOI: 10.1016/j.ajog.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Childbirth is a defining moment in anyone's life, and it occurs 140 million times per year. Largely a physiologic process, parturition does come with risks; one mother dies every two minutes. These deaths occur mostly among healthy women, and many are considered preventable. For each death, 20 to 30 mothers experience complications that compromise their short- and long-term health. The risk of birth extends to the newborn, and, in 2020, 2.4 million neonates died, 25% in the first day of life. Hence, intrapartum care is an important priority for society. The American Journal of Obstetrics & Gynecology has devoted two special Supplements in 2023 and 2024 to the clinical aspects of labor at term. This article describes the content of the Supplements and highlights new developments in the induction of labor (a comparison of methods, definition of failed induction, new pharmacologic agents), management of the second stage, the value of intrapartum sonography, new concepts on soft tissue dystocia, optimal care during the third stage, and common complications that account for maternal death, such as infection, hemorrhage, and uterine rupture. All articles are available to subscribers and non-subscribers and have supporting video content to enhance dissemination and improve intrapartum care. Our hope is that no mother suffers because of lack of information.
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Affiliation(s)
- Roberto Romero
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI.
| | | | - Karim D Kalache
- Department of Clinical Obstetrics and Gynecology, Weill Cornell Medical College-Qatar Division, Doha, Qatar; Division of Maternal-Fetal Medicine, Women's Services, Sidra Medicine, Doha, Qatar
| | - Joanne Stone
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY
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Ghose I, Wiley RL, Ciomperlik HN, Chen HY, Sibai BM, Chauhan SP, Mendez-Figueroa H. Association of adverse outcomes with three-tiered risk assessment tool for obstetrical hemorrhage. Am J Obstet Gynecol MFM 2023; 5:101106. [PMID: 37524259 DOI: 10.1016/j.ajogmf.2023.101106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/23/2023] [Accepted: 07/14/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Guidelines promote stratification for the risk for postpartum hemorrhage among parturients, although the evidence for the associated differential morbidity among the groups remains inconsistent among published reports. OBJECTIVE Using the California Maternal Quality Care Collaborative schema modified by the American College of Obstetrics and Gynecology, we compared the composite maternal hemorrhagic outcome and the composite neonatal adverse outcome among singletons who were categorized after delivery by the researchers as low-, medium-, or high-risk for postpartum hemorrhage. We hypothesized that the composite outcomes would be significantly different among the individuals in the different 3-tiered categories. STUDY DESIGN This was a retrospective cohort study of all singleton parturients with a gestational age of at least 14 weeks who delivered at a single site within 1 year. The composite maternal hemorrhagic outcome included any of the following: estimated blood loss ≥1000 mL, use of uterotonics (excluding prophylactic oxytocin) or Bakri balloon, surgical management of postpartum hemorrhage, blood transfusion, hysterectomy, thromboembolism, admission to the intensive care unit, or maternal death. The composite neonatal adverse outcome included Apgar score <7 at 5 minutes, birth injury, bronchopulmonary dysplasia, intraventricular hemorrhage, neonatal seizure, sepsis, ventilation > 6 hrs., brachial plexus palsy, hypoxic-ischemic encephalopathy, or neonatal death. Multivariable Poisson regression models with robust error variance were used to estimate the adjusted relative risks with 95% confidence intervals. RESULTS Of the 4544 deliveries in the study period, 4404 (96.7%) met the inclusion criteria, and among them, 1745 (39.6%) were categorized as low, 1376 (31.2%) as medium, and 1283 (29.1%) as high risk. Overall, 941 (21.4%) participants experienced the composite maternal hemorrhagic outcome with 285 (16.4%) of those being in the low-risk group, 319 (23.2%) in the medium-risk group, and 337 (26.3%) in the high-risk group. Among all parturients, 95.7% in the low-, 89.4% in the medium-, and 85.3% in the high-risk group neither had an estimated blood loss or a quantified blood loss ≥1000 mL nor were transfused. After multivariable adjustment and when compared with the low-risk group, there was a significantly higher risk for the composite maternal hemorrhagic outcome in the medium-risk group (adjusted relative risk, 1.23; 95% confidence interval, 1.05-1.43) and in the high-risk group (adjusted relative risk, 1.51; 95% confidence interval, 1.31-1.75). Overall, 366 newborns (8.4%) developed the composite neonatal adverse outcome with 76 (4.2%) in of those being in the low-risk group, 153 (11.3%) in the medium-risk group, and 140 (11.1%) in the high-risk group. After multivariable adjustment and when compared with the low-risk group, there were no significant differences in the composite neonatal adverse outcome in the medium- (adjusted relative risk, 1.27; 95% confidence interval, 0.97-1.68) or the high-risk group (adjusted relative risk, 1.29; 95% confidence interval, 0.98-1.68). CONCLUSION Although 8 of 10 parturients categorized as high risk neither had blood loss ≥1000 mL nor underwent transfusion, the risk stratification provides information regarding the composite maternal hemorrhagic outcome.
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Affiliation(s)
- Ipsita Ghose
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Rachel L Wiley
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Hailie N Ciomperlik
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Han-Yang Chen
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Baha M Sibai
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX.
| | - Hector Mendez-Figueroa
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
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Emergency Decision-making Method of Unconventional Emergencies in Higher Education Based on Intensive Learning. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2022; 2022:4317697. [PMID: 36213041 PMCID: PMC9534682 DOI: 10.1155/2022/4317697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/03/2022] [Accepted: 08/20/2022] [Indexed: 11/18/2022]
Abstract
In order to improve the emergency decision-making and management ability of unconventional emergencies in Colleges and universities, an emergency decision-making method for unconventional emergencies in Colleges and Universities based on reinforcement learning is proposed. The function of the emergency decision-making model of unconventional emergencies in Colleges and universities is constructed, and the optimal control of the emergency decision-making process of unconventional emergencies in Colleges and universities is realized by using the queuing theory model. Based on the sub-sequence decomposition method, the reinforcement learning function is optimized. Combined with big data scheduling and the empirical mode decomposition method, the effective probability density function of emergency decision-making for unconventional emergencies in higher education is calculated, and the optimal solution vector analysis of emergency management and scheduling decision-making for unconventional emergencies in Colleges and universities is realized according to parameter estimation and quantitative optimization results. The test results show that this method has a good ability to optimize and schedule the emergency decision-making of unconventional emergencies in higher education, and has strong convergence. This method improves the emergency response-ability, and the time cost is short.
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Calim SI, Ulas SC, Demirci H, Tayhan EB. Effects of high fidelity simulation model on midwives' shoulder dystocia management skills: An educational İntervention study. Niger J Clin Pract 2022; 25:773-778. [DOI: 10.4103/njcp.njcp_1393_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Masturzo B, Zonca M, Germano C, Girlando F, Diacono D, Attini R, Menato G, Benedetto C. Operative vaginal delivery: all you should know. Minerva Obstet Gynecol 2021; 73:45-56. [PMID: 33821598 DOI: 10.23736/s2724-606x.21.04679-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Over the last three decades, the decrease in operative vaginal delivery (OVD) has lead to an increase in the rate of cesarean sections, giving rise to intense debate amongst healthcare providers. As the use of vacuum and forceps requires personnel be adequately trained so as to become familiar with the correct use of instruments, the lack of skilled and experienced instructors may well lead to this technique being discarded in the near future. The aim of this study was to review the literature, compare the recommendations from international OVD guidelines and to illustrate the correct technique of obstetrical vacuum and forceps application to promote OVD among clinicians as a safe way of delivery.
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Affiliation(s)
- Bianca Masturzo
- Sant'Anna University Hospital, Città della Salute e della Scienza, Turin, Italy -
| | - Marina Zonca
- Sant'Anna University Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Chiara Germano
- Department of Surgical Sciences, Sant'Anna University Hospital, Turin, Italy
| | - Flavia Girlando
- Department of Surgical Sciences, Sant'Anna University Hospital, Turin, Italy
| | - Debora Diacono
- Department of Surgical Sciences, Sant'Anna University Hospital, Turin, Italy
| | - Rossella Attini
- Sant'Anna University Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Guido Menato
- Unit of Obstetrics and Gynaecology 2, Department of Surgical Sciences, Sant'Anna University Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Chiara Benedetto
- Unit of Obstetrics and Gynaecology 1, Department of Surgical Sciences, Sant'Anna University Hospital, Città della Salute e della Scienza, Turin, Italy
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di Pasquo E, Ramirez Zegarra R, Kiener AJO, Gobbi L, Dall'Asta A, Fieschi L, Cugini L, Copelli M, Frusca T, Ghi T. Usefulness of an Intrapartum Ultrasound Simulator (IUSim™) for Midwife Training: Results from an RCT. Fetal Diagn Ther 2020; 48:120-127. [PMID: 33296898 DOI: 10.1159/000512047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/05/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We conducted a randomized study to determine whether a training session on a dedicated simulator (IUSim™) would facilitate the midwives in learning the technique of transperineal intrapartum ultrasound. METHODS Following a 30-min multimedia presentation including images and videos on how to obtain and measure the angle of progression (AoP) and the head-perineum distance (HPD), 6 midwives with no prior experience in intrapartum ultrasound were randomly split into 2 groups: 3 of them were assigned to the "training group" and 3 to the "control group." The midwives belonging to the former group were taught to measure the 2 sonographic parameters during a 3-h practical session conducted on IUSim™ under the supervision of an expert obstetrician. In the following 3 months, all the 6 midwives were asked to independently perform transperineal ultrasound during their clinical practice and to measure on the acquired images either the AoP or the HPD. The sonographic images were examined in blind by the teaching obstetrician who assigned a 0-3 score to the image quality (IQS) and to the measurement quality (MQS). RESULTS A total of 48 ultrasound images (24 patients) from 5 midwives were acquired and included in the study analysis. A midwife of the "training group" declined participation after the practical session. Independently from the randomization group, the image quality score (IQS + MQS) was significantly higher for the HPD compared with the AoP (2.5 ± 0.66 vs. 1.79 ± 1.14; p = 0.01). In the training group, the MQS of either AoP (2.66 ± 0.5 vs.1.46 ± 1.45. p = 0.038) and the HPD (2.9 ± 0.33 vs. 1.87 ± 0.83 p = 0.002) was significantly higher in comparison with the control group, while the IQS of both measurements was comparable between the 2 groups (1.91 ± 1.24 vs. 2.25 ± 0.865; p = 0.28). CONCLUSION The use of a dedicated simulator may facilitate the midwives in learning how to measure the AoP and the HPD on transperineal ultrasound images.
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Affiliation(s)
- Elvira di Pasquo
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Ruben Ramirez Zegarra
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy.,Frankfurt Oder Klinikum, Frankfurt, Germany
| | - Ariane J O Kiener
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Laura Gobbi
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Andrea Dall'Asta
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Laura Fieschi
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Lodovica Cugini
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Monica Copelli
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Tiziana Frusca
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Tullio Ghi
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy,
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Montanaro J. Using In Situ Simulation to Develop a Prone Positioning Protocol for Patients With ARDS. Crit Care Nurse 2020; 41:e1-e13. [PMID: 33221829 DOI: 10.4037/ccn2020830] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Acute respiratory distress syndrome carries a 40% mortality rate. Prone positioning remains underused owing to clinicians' low degree of confidence, concern about the risk of adverse outcomes, and lack of staff competency training. LOCAL PROBLEM AND PURPOSE A prone positioning protocol and educational program were needed in an intensive care unit to achieve compliance with best practices for treating acute respiratory distress syndrome patients. METHODS An initial survey was conducted to measure staff confidence and competency in prone positioning. A literature review was performed, and a plan-do-study-act approach was used to develop a protocol through in situ simulation involving mock patients. A training video and a simulation scenario using a high-fidelity manikin were developed to facilitate staff education. Staff were surveyed again after training. INTERVENTIONS During the simulation scenario, interdisciplinary clinicians learned to apply the protocol and resupinate the patient during a simulated emergency. The training video was later used for "just in time" education minutes before actual prone positioning events. RESULTS A total of 25 critical care nurses, 11 respiratory therapists, and 10 physicians completed the initial survey and simulation training. The survey showed that staff lacked confidence and competency in prone positioning. Staff demonstrated competence during the simulation sessions, and posttraining surveys indicated increased confidence. After the educational program, prone positioning was successfully used for 6 critically ill acute respiratory distress syndrome patients. CONCLUSIONS In situ simulation and interdisciplinary collaboration increase standardization of high-risk, underused procedures, improving staff confidence and competence as well as patient safety.
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Affiliation(s)
- Jessica Montanaro
- Jessica Montanaro is assistant nursing care coordinator in the medical/surgical/trauma intensive care unit, Mount Sinai Morningside Hospital, New York, New York
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Hotton EJ, Merialdi M, Crofts JF. Simulation for intrapartum care: from training to novel device innovation. Minerva Obstet Gynecol 2020; 73:82-93. [PMID: 33196635 DOI: 10.23736/s2724-606x.20.04669-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Improving maternal and perinatal care is a global priority. Simulation training and novel applications of simulation for intrapartum care may help to reduce preventable deaths worldwide. Evaluation studies have published details of the effectiveness of simulation training for obstetric emergencies, exploring clinical and non-clinical factors as well as the impact on patient outcomes (both maternal and neonatal). This review summarized the many uses of simulation in obstetric emergencies from training to assessment. It also described the adaption of training in low-resource settings and the evidence behind the equipment recommended to support simulation training. The review also discussed novel applications for simulation such as its use in the development of a new device for assisted vaginal birth and its potential role in Cesarean section training. This study analyzed the financial implications of simulation training and how this may impact the delivery of such training packages, considering that simulation should be developed and utilized as a key tool in the development of safe intrapartum care in both emergency and non-emergency settings, in innovation and product development.
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Affiliation(s)
- Emily J Hotton
- Department of Women and Children's Research, Southmead Hospital, Translational Health Sciences, University of Bristol, Bristol, UK -
| | | | - Joanna F Crofts
- Department of Women and Children's Research, Southmead Hospital, Translational Health Sciences, University of Bristol, Bristol, UK
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Capozzi VA, Rosati A, Sozzi G, Armano G, Cianci S, Chiantera V, Scambia G, Berretta R, Frusca T. Italian survey on the residents' surgical level in gynecology and obstetrics. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 92:e2021011. [PMID: 33682831 PMCID: PMC7975951 DOI: 10.23750/abm.v92i1.10649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The present study aims to investigate the number of surgical procedures performed by Italian residents and their confidence to carry out different surgeries in obstetrics and gynecology. METHODS The present study is a national survey including all Italian gynecology and obstetrics senior residents. A questionnaire including 25 questions was provided. The free Google Forms site was used to create the survey. The study was conducted from April to October 2019. The survey started from the University Hospital of Parma, a tertiary hospital, and was sent to all the Italian post-graduation medical school in gynecology and obstetrics. An e-mail was sent to all representative residents in gynecology and obstetrics in Italy, then forwarded to all the senior residents. RESULTS Of the 555 residents enrolled, 100 joined the survey (18.2%). The analysis of the different procedures performed by residents has shown that 53%, 57%, and 77% of the residents had never performed a laparotomic, laparoscopic, and vaginal hysterectomy, respectively. The analysis of cesarean section skills has shown that 1% of residents had never performed any simple cesarean section, and 6% of residents had never performed any complex cesarean section. Fifty-two doctors in training had never performed an operative vaginal delivery. Seventy-three and ninety-three residents performed more than thirty uterine curettages and sutures of 1st or 2nd degree tears, respectively. CONCLUSIONS In Italy, senior residents are generally confident with the low-complexity procedures and also with complex cesarean sections. The number of Italian residents confident to perform a hysterectomy is poor.
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Affiliation(s)
| | - Andrea Rosati
- Gynecologic Oncology, Dipartimento per le Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Department of Gynecology and Obstetrics, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy..
| | - Giulio Sozzi
- Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy.
| | - Giulia Armano
- Department of Gynecology and Obstetrics of Parma, University of Parma, Parma, Italy.
| | - Stefano Cianci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy..
| | - Vito Chiantera
- Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy.
| | - Giovanni Scambia
- Gynecologic Oncology, Dipartimento per le Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Department of Gynecology and Obstetrics, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy..
| | - Roberto Berretta
- Department of Gynecology and Obstetrics of Parma, University of Parma, Parma, Italy.
| | - Tiziana Frusca
- Department of Gynecology and Obstetrics of Parma, University of Parma, Parma, Italy.
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Masturzo B, Ghi T, Rizzo G. Letter to Editor with regard to the article "Hybrid simulation for obstetrics training: A systematic review". Eur J Obstet Gynecol Reprod Biol 2020; 251:278-279. [PMID: 32444174 DOI: 10.1016/j.ejogrb.2020.03.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/25/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Bianca Masturzo
- Division of Maternal Fetal Medicine, Sant'Anna Hospital, University of Turin, Turin, Italy.
| | - Tullio Ghi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giuseppe Rizzo
- Division of Maternal Fetal Medicine, Ospedale Cristo Re, University of Rome Tor Vergata, Rome, Italy
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