Evaluation of Suzor forceps training by studying obstetric anal sphincter injuries: a retrospective study

Abstract

Background Instrumental deliveries are an unavoidable part of obstetric practice. Dedicated training is needed for each instrument. To identify when a trainee resident can be entrusted with instrumental deliveries by Suzor forceps by studying obstetric anal sphincter injuries. Methods A French retrospective observational study of obstetric anal sphincter injuries due to Suzor forceps deliveries performed by trainee residents was conducted from November 2008 to November 2016 at Limoges University Hospital. Perineal lesion risk factors were studied. Sequential use of a vacuum extractor and then forceps was also analyzed. Results Twenty-one residents performed 1530 instrumental deliveries, which included 1164 (76.1%) using forceps and 89 (5.8%) with sequential use of a vacuum extractor and then forceps. Third and fourth degree perineal tears were diagnosed in 82 patients (6.5%). Residents caused fewer obstetric anal sphincter injuries after 23.82 (+/− 0.8) deliveries by forceps (p = 0.0041), or after 2.36 (+/− 0.7) semesters of obstetrical experience (p = 0.0007). No obese patient (body mass index> 30) presented obstetric anal sphincter injuries (p = 0.0013). There were significantly fewer obstetric anal sphincter injuries after performance of episiotomy (p < 0.0001), and more lesions in the case of the occipito-sacral position (p = 0.028). Analysis of sequential instrumentation did not find any additional associated risk. Conclusion Training in the use of Suzor forceps requires extended mentoring in order to reduce obstetric anal sphincter injuries. A stable level of competence was found after the execution of at least 24 forceps deliveries or after 3 semesters (18 months) of obstetrical experience.

Analysis of the obstetrician's posture and gestures during a simulated forceps delivery

“…The abovementioned analysis elements of the different techniques adopted strongly suggest that, as has been shown for many interventions such as spooning, or the occurrence of obstetrical lesions of the anal sphincter during forceps deliveries (7,19), the techniques for performing forceps delivery adopted by the experienced obstetricians in the present study seem better than those adopted by less experienced obstetricians.…”

“…According to the literature, learning instrumental delivery using forceps on a mannequin makes it possible to both reduce obstetric lesions of the anal sphincter linked to deliveries performed before the obstetrician is su ciently experienced (7), and to personalize the training of learners in the absence of any urgent and stressful situation (20). Therefore, learning instrumental delivery using forceps on a mannequin could help to compensate for the drop in the number of forceps deliveries performed by obstetricians.…”

Analysis of the obstetrician's posture and movements during a simulated forceps delivery

“…The abovementioned analysis elements of the different techniques adopted strongly suggest that, as has been shown for many interventions such as forceps blade placement, or the occurrence of obstetrical lesions of the anal sphincter during forceps deliveries [ 9 , 24 ], the techniques for performing forceps delivery adopted by the experienced obstetricians in the present study seem better than those adopted by less experienced obstetricians.…”

“…A significant number of the young obstetricians in the present study, who were still in training, mentioned during the experiments a lack of training in instrumental deliveries during their internship. According to the literature, learning instrumental delivery using forceps on a mannequin makes it possible to both reduce obstetric lesions of the anal sphincter linked to deliveries performed before the obstetrician is sufficiently experienced [ 9 ], and to personalize the training of learners in the absence of any urgent and stressful situation [ 25 ]. Therefore, learning instrumental delivery using forceps on a mannequin could help to compensate for the drop in the number of forceps deliveries performed by obstetricians and its accompanying decline in skill acquisition.…”

“…Moreover, it has been clearly established that a less-trained doctor risks performing the technique in an improper manner, which consequently risks inducing serious and avoidable maternal injuries [ 9 ]. The significant drop in the use of forceps inevitably leads to a drop in the transmission of expertise by association and, consequently, to a progressive decrease in the number of expert obstetricians.…”