Assessment of a full dilatation cesarean delivery simulator
Nicola Vousden1, Zoya Hamakarim, Annette Briley
1Division of Women's Health, Women's Health Academic Centre, and Maternal and Fetal Research Unit, King's College London, and the Division of Reproduction and Endocrinology, St Thomas' Hospital, London, West Middlesex University Hospital National Health Service Trust, Middlesex, and the Department of Obstetrics and Gynaecology, National Health Service Fife, Fife, United Kingdom.
Objective:
To assess a full dilatation cesarean delivery simulator and to establish expert consensus on the most effective techniques for safe delivery.
Methods:
Three delivery scenarios with increasing degrees of difficulty were tested. Face and content validity were assessed using visual analog scale (VAS) scores on how realistic the simulator was and how useful it would be for training, respectively. Construct validity was assessed by comparing success at delivery and time taken between senior doctors and junior doctors. Expert opinion was sought through a questionnaire.
Results:
The training scenarios were undertaken by 30 doctors working in the specialty of obstetrics and gynecology. The number of participants able to deliver and the perceived difficulty they experienced correlated with the difficulty level of the three scenarios (success: scenario 1, 100% [n=30]; scenario 2, 90% [n=27]; and scenario 3, 62% [n=16] P<.05; mean VAS: scenario 1, 29/100; scenario 2, 42/100; and scenario 3, 88/100; P<.001). Average time to delivery for each scenario was 45 seconds, 43 seconds, and 109 seconds, respectively (P<.001). Overall, 87% found the simulator to be realistic (median VAS 58/100, interquartile range 40-74) and 93% thought it would be useful as a training device (median VAS 80/100, interquartile range 55-97). Questionnaires were received from 47 consultants with an average of 18 years of experience. High uterine incision and assistance to push the fetal head up transvaginally were the only two techniques reported by more than half of the respondents.
Conclusion:
This full dilatation cesarean delivery simulator has been validated as a training device; we believe it should be used to develop a consensus for accepted techniques.
