Purpose: To assess improvement in resident confidence, assessment and documentation of fetal occiput position of patients in labor following an educational intervention and initiation of a new electronic medical record template.
Background:
Fetal malposition can lead to abnormal progression of the second stage of labor. Occiput posterior position is associated with a twofold increase in operative vaginal delivery and a threefold increase in cesarean delivery. Fetal position assessment and documentation is critical when applying forceps or applying a vacuum, and simulation and didactics have the opportunity to increase this documentation and aid in patient safety.
Methods: Investigators completed chart review prior to the educational intervention for laboring patients from November and December of 2020 and post-intervention patients for March and April of 2021.The study conducted a pre and post educational intervention survey of all residents (n=20). The intervention consisted of a didactic session of fetal skull anatomy, assessment of fetal position with pelvic simulators and demonstration of use of ultrasound to determine fetal position abdominally and at the perineum. The study then implemented standardized labor progress note dot phrase templates to improve documentation of fetal position. Descriptive statistics were calculated for overall sample.
Results: No significant difference in baseline characteristics; age, gravidity, parity, BMI and gestational age were found between pre and post intervention laboring patients. Pre intervention n=92 and post intervention n=82. Documented exams >8cm increased from 18% to 49% in the post intervention time period among residents. According to the resident survey tool, confidence and knowledge following the intervention improved, 95% of residents felt somewhat or extremely comfortable with assessment of fetal occiput position post intervention. Similarly, 75% of residents remembered to assess for fetal position most of the time or always post intervention, and 65% of residents felt that the educational intervention helped with their assessment of fetal occiput position.
Discussions: These types of interventions, especially early in clinical training have the potential to improve many of our skills as obstetricians. This didactic curriculum will become a part of yearly simulation for our residency program. It can also lead to more comfort with interventions including operative delivery and manual rotation.
Topics: CREOG & APGO Annual Meeting, 2022, GME,
Emile Redwood, MD, NYU Langone Hospital Long Island; Elisabeth Sulger, MD; Nur Afsar, MD; Meredith Akerman, MS; Karyn Wat, MD
