A retrospective cohort study of the impact of In Time obstetric simulation training on management of vaginal breech deliveries

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.

Impact of timely obstetric simulation on vaginal breech delivery management

“…15 Our results echo the CNGOF's 2020 guidelines, which state that experienced obstetricians can minimize neonatal complications for both vaginal and elective cesarean deliveries in term breech pregnancies. 15 Furthermore, our findings align with Hardy et al, emphasizing simulation's pivotal role in enhancing medical practitioners' confidence and expertise. 13 This study has some limitations.…”

“…12,13 Recent evaluations of PROMPT focus more on non-technical skills and specific outcomes like Apgar scores at 1 minute instead of traditional measures like the 5-minute Apgar scores or maternal blood loss. 11,[13][14][15] As per Draycott's 2015 observations, the success of obstetric emergency training can differ based on the nature of data and training environment. [10][11][12][13] Factoring in local clinical conditions can amplify the results.…”

“…A 2018 review reinforced the benefit of simulation-based training in boosting physician performance in obstetrics. 15 Moreover, in 2017, the Royal College of Obstetricians and Gynecologists pinpointed the importance of specific ultrasound findings during labor in foretelling vaginal breech delivery outcomes. 15 Our results echo the CNGOF's 2020 guidelines, which state that experienced obstetricians can minimize neonatal complications for both vaginal and elective cesarean deliveries in term breech pregnancies.…”

“…15 Moreover, in 2017, the Royal College of Obstetricians and Gynecologists pinpointed the importance of specific ultrasound findings during labor in foretelling vaginal breech delivery outcomes. 15 Our results echo the CNGOF's 2020 guidelines, which state that experienced obstetricians can minimize neonatal complications for both vaginal and elective cesarean deliveries in term breech pregnancies. 15 Furthermore, our findings align with Hardy et al, emphasizing simulation's pivotal role in enhancing medical practitioners' confidence and expertise.…”

Management of term breech presentation

“…Simulation training is effective for midwives and obstetricians to acquire the skills needed for management of the unplanned vaginal breech delivery, with improved scores in technique and safety. [47][48][49] However, evidence suggests that while experience and confidence in vaginal breech increases with the number of procedures performed; this is not reflected in intention to offer these procedures in clinical practice. Senior trainees are also less likely to want to manage VBB owing to apprehension about adverse outcomes and potential medicolegal consequences.…”