Implementation of Low-Cost Obstetric Hemorrhage Simulation Training Models for Resident Education

Global obstetric anaesthesia: bridging the gap in maternal health care inequities through partnership in education

Maternal mortality rates are unacceptably high globally. Low- and middle-income countries (LMICs) face challenges of an inadequate anaesthesia workforce, under-resourced healthcare systems and sub-optimal access to labour and delivery care, all of which negatively impact maternal and neonatal outcomes. In order to effect the changes in surgical-obstetric-anaesthesia workforce numbers advocated by the Lancet Commission on Global Surgery to support the UN sustainable development goals, mass training and upskilling of both physician and non-physician anaesthetists is imperative. The implementation of outreach programmes and partnerships across organisations and countries has already been shown to improve the provision of safe care to mothers and their babies, and these efforts should be continued. Short subspecialty courses and simulation training are two cornerstones of modern obstetric anaesthesia training in poorly resourced environments. This review discusses the challenges to accessing quality maternal healthcare in LMICs and the use of education, outreach, partnership and research to protect the most vulnerable women from coming to harm in the peripartum period.

Successful management of perimortem cesarian section with two types of pelvic packing; a case report

Perimortem cesarean is rare and one of the worst possible scenarios in obstetrics. Multidisciplinary approach and speed are extremely important. Pelvic packing in massive postpartum hemorrhages is a method which obstetricians do not commonly use. The patient who had cardiac arrest during travail was successfully managed with a peripartum hysterectomy and two different types of pelvic packing after perimortem cesarean. The mother and baby were healthily discharged. Fetal and maternal survival after perimortem cesarean is quite low. The most important factor determining survival is speed. Pelvic packing is effective in postpartum unstoppable bleeding.

Simulation in obstetric anesthesia: an update

PURPOSE OF REVIEW

Simulation training (crew resource management training and scenario training) has become an important tool in the education of anesthesiologists. This review summarizes recent research performed in this area, focusing more specifically on obstetric anesthesia.

RECENT FINDINGS

Simulation training is becoming more integrated in the modern education of anesthesiologists. Research regarding the most effective way to perform simulation training in terms of learning outcomes and long-term skill retention has started to appear. Scenarios which are played independently and that allow for simulated mortality, as well as relaxation techniques before debriefing might have positive effects in this regard. Furthermore, simulation has been investigated as a tool to improve patient safety in low-resource settings. In addition, simulation training in the domain of obstetrics has been rapidly expanding and has an important role in this field of medicine as well.

SUMMARY

Simulation training has acquired a central role in modern education of anesthesiologists. Further research regarding elements to optimize simulation training in terms of learning outcomes and long-term skill retention is desirable. In addition, little data exist concerning the effect of simulation training on possible improvement of patient outcomes in anesthesia.

[Intrauterine tamponade: Practices and training assessment]

OBJECTIVES

The main objective was to describe the practices of a French center regarding the use of intrauterine tamponade. The secondary objective was to describe the training of residents in the use of intrauterine tamponade (IUT).

METHODS

This was a practice survey conducted through an anonymous quiz sent to residents in France between May 1, 2018 and July 1, 2019. Responses from first year residents were excluded. The data concerned the practices of the centers (mode of delivery, mode of insertion, ultrasound control, use of vaginal gauze or antibiotic prophylaxis) as well as the feeling of the residents concerning their training in using of the intrauterine tamponade (frequency, training sessions, learning difficulties).

RESULTS

We obtained 145 responses to represent all regions of France. Responses from 27/28 centres were obtained. All the centres use it during cesarean section and after vaginal delivery. Vaginal gauze is used in 74% of cases and 65% use antibiotic prophylaxis. A specific training during the residentship is described in only 26% of cases and 21% of residents say they have never used an IUT.

CONCLUSION

Intrauterine tamponade is a technique widely used in France, regardless of the mode of delivery. The training of residents is essential, especially since the simulation is perfectly adapted to the learning for using intrauterine tamponade.

Planning, construction and use of handmade simulators to enhance the teaching and learning in Obstetrics*

to describe the development process and present the results of a pilot study on the use of low-cost handmade simulators for teaching and learning Obstetrics.