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Effect Of “Just-In-Time” Monthly Resident Forceps Simulations On Operative Vaginal Deliveries And Maternal Morbidity

Purpose: Our aim was to evaluate FAVD frequency before and after starting a “just-in-time” simulation program. We hypothesized that monthly simulation would increase FAVDs at our institution.


Background: Literature supporting simulation as a means to increase forceps-assisted vaginal deliveries (FAVD) and decrease second stage cesareans remains limited.


Methods: In September 2021, we implemented a monthly “just-in-time” team-based resident forceps simulation curriculum after COVID-19-related interruption of a previous annual, large-group program. Patients who reached the second stage of labor with singleton, non-anomalous, live-born infants were included. The primary outcome was FAVD in the 9 months predating the COVID-19 pandemic (epoch 1, 06/01/19-02/29/20) compared to the 9 months following program implementation (epoch 2, 10/01/21-6/30/22). Secondary outcomes included second stage cesarean, forceps-associated severe perineal laceration, blood transfusion, hemorrhage, umbilical cord pH, and APGAR scores.


Results: 10,729 women met inclusion criteria; 5,741 delivered during epoch 1 and 4,988 during epoch 2. FAVD frequency was similar in epoch 2 and epoch 1 (2.9% compared to 2.4%; RR 1.23 [0.98, 1.55], P=0.071). Second stage cesarean was unchanged in epoch 2 compared to epoch 1 (2.3% compared to 2.0%; RR 1.20 [0.93, 1.55], P=0.158). Postpartum hemorrhage occurred less frequently in epoch 2 than in epoch 1 (8.7% compared to 10.2%; RR 0.86 [0.76, 0.96], P=0.01).


Discussions: Just-in-time simulation did not lead to an increased rate of FAVD. There was no change in the rate of second stage cesarean delivery or forceps-associated severe perineal laceration. Further study of alternative means to decrease the second-stage cesarean rate is necessary.

Topics: CREOG & APGO Annual Meeting, 2023, Resident, Faculty, Clerkship Director, Osteopathic Faculty, Residency Director, Patient Care, Medical Knowledge, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Simulation, Lecture, Quality & Safety, Team-Based Learning, Maternal-Fetal Medicine, General Ob-Gyn,

General Information

Resident,Faculty,Clerkship Director,Osteopathic Faculty,Residency Director,
Patient Care,Medical Knowledge,Systems-Based Practice & Improvement,Practice-Based Learning & Improvement,
Simulation,Lecture,Quality & Safety,Team-Based Learning,
Clinical Focus
Maternal-Fetal Medicine,General Ob-Gyn,

Author Information

Joseph Fixler, MD; University of Texas Southwestern; Jamie Morgan, MD; Emily Adhikari, MD; Yevgenia Fomina, MD;

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