A 20-year-old para 2 woman had a preterm delivery at 25 weeks and 6 days, readmitted to the hospital 25 days after delivery with severe secondary postpartum haemorrhage (PPH). Uncontrolled by initial conservative management, she underwent uterine curettage followed by Bakri balloon tamponade. She later had laparotomy for continued bleeding. She was found to have uterine rupture and hysterectomy was carried out as a life-saving measure. She was transfused in total with 14 units of blood, 1 unit of platelet, 2 units of cryoprecipitate and 3 units of fresh frozen plasma. The patient had intensive therapy unit  care and was discharged home on the sixth postoperative day. The histology report showed ectatic non-constricted vessels as the cause of the secondary PPH. No myometrial tissue, products of conception or evidence of endometritis. The sequential use of uterine curettage and balloon tamponade in the aetiology of uterine rupture is a rare occurrence.

Medical simulation mimics clinical care, allowing individual health professionals and teams to develop and maintain skills necessary for safe and effective clinical care. It enables trainee surgeon practice remotely from patients thereby gaining confidence and becoming more efficient. One of the earliest examples of simulation is the construction of the game of chess in the sixth century for military training. In the last 10 years, technological advances have allowed for a wider availability and greater realism of simulation, and this has encouraged a great expansion in its use. The Experiential Learning Theory (ELT) developed by David Kolb (1982) 'comes alive' and explains well how simulation translates to deep learning. For operative gynaecology to fully take advantage of the advantages offered by the explosion of endoscopic surgery in recent years, simulation based training should be fully integrated and funded within training programmes for clinician at all stages. Simulation based training needs to be valued and adequately resourced by healthcare organisations. A skilled faculty of expert clinical facilitators should be developed to deliver high-quality simulation training. The importance of human factors training to safe care should be widely communicated.

No abstract

No abstract