A retrospective cohort study of the impact of In Time obstetric simulation training on management of vaginal breech deliveries. (17th February 2020)

• Record Type: Journal Article
• Authors: Hardy, Liesel; Garratt, Jayna‐Lee; Crossley, Brendan; Copson, Sean; Nathan, Elizabeth; Calvert, Katrina; Epee‐Bekima, Mathias
• Is Part Of: Australian and New Zealand journal of obstetrics and gynaecology. Volume 60:Number 5(2020)
• Page Start: 704
• Page End: 708
• Publication Date: 2020-02-17
• Subjects: breech delivery -- perinatal outcome -- training; Obstetrics -- Periodicals; Gynecology -- Periodicals; 618.05
• DOI: 10.1111/ajo.13132
• Languages: English
• ISSNs: 0004-8666

Abstract

Abstract : Background: Following the Term Breech Trial, vaginal breech deliveries are rarely undertaken in Australia. Some women choose to have a breech delivery following counselling, while others will present in labour with an undiagnosed breech. Clinicians need to be skilled in vaginal breech delivery despite this being a rare clinical situation. Simulation training provides a means by which uncommon clinical situations can be practised. Aim: This study aims to determine if the introduction of a simulation‐based training course is associated with an improvement in the management of vaginal breech delivery and neonatal outcomes. Methods: Cases of term vaginal breech delivery five years prior to introduction of In Time training (2001–2005) and five years after In Time training (2007–2011) were identified in a tertiary obstetric hospital (King Edward Memorial Hospital, Perth). There were 136 women identified in the pre‐training (2001–2005, n = 56) and post‐training (2007–2011, n = 80) groups. Case note review was undertaken to gather information. Results: Apgar scores of <7 at five minutes were higher in the post‐training cohort (8.8% vs 0%, P = 0.041). Arterial and venous pH readings were similar between cohorts, with a non‐significant trend toward improvement in the post‐training cohort. Special care nursery admissions and length of hospital stay were unchanged. The primary accoucheur was more likely to be a consultant (35.0% vs 16.4%) in the post‐training cohort. Appropriate manoeuvres were more likely to be used in the post‐training cohort (52.5% vs 44.6%). Conclusions: Obstetric In Time simulation training improved seniority of accoucheur and documented appropriate manoeuvres in the management of term vaginal breech delivery.