![]() ![]() Common chief complaints include painful contractions, vaginal bleeding/bloody show, and fluid leakage from the vagina. Women will often self-present to obstetrical triage with concern for the onset of labor. Initial Evaluation and Presentation of Labor Medical professionals use the information they obtain from monitoring and cervical exams to determine the patient's stage of labor and monitor labor progression. Cardiotocography is used to monitor the frequency and adequacy of contractions. Fetal heart monitoring is employed nearly continuously to assess fetal well-being throughout labor. ![]() Serial cervical examinations are used to determine cervical dilation, effacement, and fetal position, also known as the station. Clinicians typically use multiple modalities to monitor labor. This triad is classically referred to as the passenger, power, and passage. Successful labor involves three factors: maternal efforts and uterine contractions, fetal characteristics, and pelvic anatomy. The first stage is further divided into two phases. 2006 195:1489-92.Labor is the process through which a fetus and placenta are delivered from the uterus through the vagina. Simulation training in the obstetrics and gynecology clerkship. Simulation training and resident performance of Singleton vaginal breech delivery. Deering S, Bowen J, Hodor J, Satin AJ.Obstetric simulation for medical student, resident, and fellow education. A randomized controlled trial of birth simulation for medical students. DeStephano C, Chou B, Patel S, Slattery R, Hueppchen N.Noelle Maternal and Neonatal Birthing Simulator The following table lists some of the available simulation models and their relative cost: Model Name The following is a list of resources that may be helpful in augmenting your didactic presentations in these areas: Resource Name Placenta appears intact and grossly normal with 3 vessel cord. Perineum and vagina inspected – small 2nd degree perineal laceration repaired under local anesthesia with 2-0 and 3-0 vicryl-rapide suture in the usual fashion. Placenta delivered via continuous cord traction. Head delivered atraumatically, body delivered without difficulty. Delivered LOA, no nuchal cord, clear fluid. NSVD of a live female infant, 3000 gm and Apgars 9/9. Massage fundus appropriately (before or after placenta)ĭescription of amniotic fluid (presence or absence of meconium)ĭescription of lacerations (presence or absence) Initiate warming and drying of depressed infantĮxamine cervix & perineum for lacerations The following checklist may be used as a component of the training session and/or as a component of a performance assessment as part of an objective structured clinical examination.ĭescribe the steps of a normal vaginal delivery After completing the delivery, complete a delivery note.Examine the cervix and perineum for lacerations.Perform a vaginal exam to determine initial fetal station and position.She has had 2 vaginal deliveries of 3.6-kg (8 lb) infants. She has had an uncomplicated prenatal course. The women states she has a strong desire to push and is leaking clear fluid. The estimated fetal weight is 3.15 kg (7 lb). The fetal heart rate is 150 beats per minute. For the purpose of medical student training, a low-fidelity simulator is expected to produce equivalent learning outcomes to high-fidelity simulators.įollowing completion of appropriate didactic or self-directed background learning, students should participate in a mentored hands-on practice session/lab.Ī 26-year-old gravida 3 para 2 40 2/7 weeks has presented to the triage room on Labor and Delivery. Therefore, the selection of an appropriate simulation model should be based on the scope of the learning objectives. It is important to note that more realistic (high-fidelity) simulators do not necessarily provide better skills attainment as compared to less-realistic (low-fidelity) simulators (1). Therefore we suggest that birth simulators be used to teach vaginal delivery skills to medical students.Ī number of models for training in vaginal delivery can be purchased from commercial vendors. Although investigations describing the efficacy of these models are limited, available evidence suggests that training novices with these models results in better overall performance and higher levels of confidence in their skills to perform vaginal deliveries (3,4). Simulation allows students to learn, make mistakes, and receive feedback in a safe setting (1,2). The alternative to clinical practice is structured skills training using an obstetrical birth simulator. Reliance upon clinical experience as a “gold-standard” for training in vaginal delivery can be limited by several factors, namely, inadequate patient availability, unpredictable emergencies, and lack of standardization of training.
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