Obstetric emergency drills

OBJECTIVE: To determine the effect of standardized education specific to maternal resuscitation on nurses' confidence and competence during obstetric emergencies and to determine the cost savings associated with the program. DESIGN: Pre- and postintervention surveys designed to measure perceived confidence and competence in resuscitation before and after Advanced Cardiac Life Support (ACLS) certification in combination with obstetric drills. SETTING: The project was conducted at a 12-bed labor and delivery, mother/baby unit in an acute care, community-based hospital in Northwest Arkansas...

An estimated 289,000 maternal deaths, 2.6 million stillbirths and 2.4 million newborn deaths occur globally each year, with the majority occurring around the time of childbirth. The medical and surgical interventions to prevent this loss of life are known, and most maternal and newborn deaths are in principle preventable. There is a need to build the capacity of health-care providers to recognize and manage complications during pregnancy, childbirth and the post-partum period. Skills-and-drills competency-based training in skilled birth attendance, emergency obstetric care and early newborn care (EmONC) is an approach that is successful in improving knowledge and skills...

UNLABELLED: To assess the value of simulation based training in the management of obstetric emergencies. METHOD: A search by keywords: obstetrics, gynecology, simulation, drills, emergency training restricted to randomized trials led to a selection of eight articles. RESULTS: Shoulder dystocia simulation unmasked deficiencies in performing Mc Robert maneuver in nearly 20% of doctors in training as well as ineffective and potentially harmful maneuver such as pressure on the uterine fundus...

Cardiac arrest in pregnancy is a rare but catastrophic obstetric emergency, with a quoted incidence of 1:20,000 pregnancies. Speedy multidisciplinary interventions are crucial for good maternal and foetal outcomes. A perimortem caesarean section (PMCS) initiated within 4 min of onset of cardiac arrest to minimise the effect of aortocaval compression on cardiopulmonary resuscitation (CPR) has been recommended as a key intervention, which is likely to improve survival of both mother and foetus. Sudden collapse is uncommon in pregnant women and their management is more challenging than in a non-pregnant patient...

Patient care emergencies may occur at any time in any setting, particularly the inpatient setting. It is important that obstetrician-gynecologists prepare themselves by assessing potential emergencies, establishing early warning systems, designating specialized first responders, conducting emergency drills, and debriefing staff after actual events to identify strengths and opportunities for improvement. Having such systems in place may reduce or prevent the severity of medical emergencies.

OBJECTIVE: To evaluate factors contributing to obstetric emergencies, analyze the fetomaternal outcome and role of obstetric drill in facing these emergencies effectively. MATERIAL AND METHOD: Out of 10,892 deliveries, a total of 520 women were included in this prospective study. Analysis of emergency obstetric conditions was done by evaluating incidence, various contributing factors, and fetomaternal outcome. Obstetric drill was conducted among residents repetitively...

The Rotunda Hospital (Dublin) obstetric emergency training programme (RHOET) was designed, in 2008, to meet the ongoing education and training needs of the local multidisciplinary team. Prior to its implementation, senior midwives attended the advanced life support in obstetrics (ALSO) course, and many of the obstetricians attended the Management of obstetric emergencies and trauma (MOET) and/or ALSO courses. Attendance at these off site courses meant that the only opportunity for team training was the informal and ad hoc 'drills and skills' that took place in the birthing suite...

OBJECTIVE: We documented time to key milestones and determined reasons for transport-related delays during simulated emergency cesarean. STUDY DESIGN: Prospective, observational investigation of delivery of care processes by multidisciplinary teams of obstetric providers on the labor and delivery unit at Lucile Packard Children's Hospital, Stanford, CA, USA, during 14 simulated uterine rupture scenarios. The primary outcome measure was the total time from recognition of the emergency (time zero) to that of surgical incision...

Postpartum hemorrhage (PPH) is a very common obstetric emergency with high morbidity and mortality rates worldwide. Understanding its etiology is fundamental to effectively managing PPH in an acute setting. Active management of the third stage of labor is also a key component in its prevention. Management strategies include conservative measures (medications, uterine tamponade, and arterial embolization) as well as surgical interventions (arterial ligations, compression sutures, and hysterectomy). Creating a standardized PPH protocol and running simulation-based drills with a multidisciplinary team may also help decrease maternal morbidity and improve perinatal outcomes, although further studies are needed...

There is little scientific evidence to support the majority of simulation-based maternity training programmes, but some characteristics appear to be associated with sustainability. Among these are a clear institutional-level commitment to the course, strong leadership in course organisation, a curriculum relevant to clinical practice, a nonthreatening learning environment, the establishment of multiprofessional training and the use of simulators appropriate to the learning objectives. There is still some debate on whether simulation-based sessions should be carried out in dedicated training time outside normal working hours or in ad-hoc drills that are run during clinical sessions, whether they should be located in clinical areas, simulation centres, or both, and whether or not they should include standardised generic teamwork training sessions...

Simulation can be used to teach technical skills, to evaluate clinician performance, to help assess the safety of the environment of care, and to improve teamwork. Each of these has been successfully demonstrated in obstetric anesthesia simulation. Task simulators for epidural placement, failed intubation, and blood loss estimation seem to improve performance. Resident performance in an emergency cesarean delivery can be measured and assessed against his/her peers. Running simulated crises on a labor and delivery unit (in situ drills) can help to identify and correct potential safety concerns (latent errors) without exposing patients to the risks associated with these concerns...

A training package designed to train health care providers in the management of common obstetric and newborn complications using a competency based 'skills and drills' approach is used in Bangladesh and India as one of the interventions under the 'Making it Happen' programme. The programme was commenced in 2009 and aims to reduce maternal and newborn mortality and morbidity by improving health care providers' capacity to deliver Essential (Emergency) Obstetric and Newborn Care (EOC&NC) thus increasing the availability and quality of these services...

Patient care emergencies may periodically occur at any time in any setting, particularly the inpatient setting. To respond to these emergencies, it is important that obstetrician-gynecologists prepare themselves by assessing potential emergencies that might occur, creating plans that include establishing early warning systems, designating specialized first responders, conducting emergency drills, and debriefing staff after actual events to identify strengths and opportunities for improvement. Having such systems in place may reduce or prevent the severity of medical emergencies...

OBJECTIVE: To develop and evaluate a team-centered shoulder dystocia protocol. METHODS: This project was undertaken in two phases. The first phase consisted of protocol development, during which a basic protocol was initially developed on the basis of targeted interviews with obstetric care providers and then refined through iterative performances of the protocol. The second phase consisted of dissemination of the final protocol to obstetric providers using low-fidelity simulation...

OBJECTIVE: To identify specific aspects of teamworking associated with greater clinical efficiency in simulated obstetric emergencies. DESIGN: Cross-sectional secondary analysis of video recordings from the Simulation & Fire-drill Evaluation (SaFE) randomised controlled trial. SETTING: Six secondary and tertiary maternity units. SAMPLE: A total of 114 randomly selected healthcare professionals, in 19 teams of six members...

OBJECTIVE: To estimate the effects of computerized charting and shoulder dystocia (SD) simulation drills on the documentation of SD. METHODS: 180 cases of SD were evaluated in three consecutive time periods: T1: 45 written delivery notes; T2: 48 delivery notes after the implementation of a standardized SD note in the computerized medical record; T3: 87 computerized delivery notes after SD simulation drills. RESULTS: A standardized SD computerized note resulted in a significant improvement in documentation of EFW, diabetic status, time of the body delivery, fetal head position, which shoulder was impacted, anesthesia, the length of each stage of labor, NICU admission, the birth weight, and that a discussion took place with the patient...

BACKGROUND: Patient safety is a national and international priority. The purpose of this study was to understand clinicians' perceptions of teamwork during obstetric emergencies in clinical practice, to examine factors associated with confidence in responding to obstetric emergencies and to evaluate perceptions about the value of team training to improve preparedness. METHODS: An anonymous survey was administered to all clinical staff members who respond to obstetric emergencies in seven Oregon hospitals from June 2006 to August 2006...

OBJECTIVE: To assess whether team performance in simulated eclampsia is related to the knowledge, skills and attitudes of individual team members. DESIGN: Cross-sectional analysis of data from the Simulation and Fire Drill Evaluation randomised controlled trial. SETTING: Six secondary and tertiary maternity units in south-west England. PARTICIPANTS: One hundred and fourteen maternity professionals in 19 teams of six members; one senior and one junior obstetrician; two senior and two junior midwives...

INTRODUCTION: The objective of this study was to determine whether simulation was more effective than traditional didactic instruction to train crisis management skills to labor and delivery teams. METHODS: Participants were nurses and obstetric residents (<5 years experience). Both groups were taught management for shoulder dystocia and eclampsia. The simulation group received 3 hours of training in a simulation laboratory, the didactic group received 3 hours of lectures/video and hands-on demonstration...

Rupture of the uterus is a serious obstetric emergency endangering the life of both mother and fetus. In a study at the general hospital in Dohuk, Iraq, from January 2003 to December 2004, the incidence of ruptured uterus was 0.2% (42 out of 20 574 deliveries). The majority of these women (81%) were unbooked and had had no antenatal care. The range of parity was 1-13, median 7. The main causes were obstructed labour and previous caesarean scar (36% of cases each). The maternal mortality rate among these cases was 5% and the perinatal mortality rate was 62%...