Vacuum extraction: is there any need to improve the current training in the UK?

Sau, Ashis; Sau, Mita; Ahmed, Hasib; Brown, Richard N

doi:10.1111/j.0001-6349.2004.0399.x

Cited by 38 publications

(20 citation statements)

References 11 publications

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“…Such wide variations of failure and detachment rates are difficult to explain given that the vacuum devices used in the studies were similar. There are many clinical factors besides the cup itself that may influence the outcome of a vacuum extraction such as the indication for the procedure, the selection of patients and, most importantly, the operator’s familiarity and level of training with the device 20 . For example, background failure rates of 20–25% for vacuum‐assisted delivery are common in the UK, 8,9 whereas at PMGH the rate has been around 2% for many years 11,21 .…”

Section: Discussionmentioning

confidence: 99%

“…Sau et al. 20 also suggest that training issues are an important factor. They state that high rates of vacuum extraction failure in many units in the UK are due to ‘high rates of inappropriate positioning of the cup, poor assessment of orientation and position of the fetal skull.’ At Port Moresby General Hospital, vacuum extraction has been the standard method of assisting delivery from the 1960s.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A randomised controlled trial of two instruments for vacuum‐assisted delivery (Vacca Re‐Usable OmniCup and the Bird anterior and posterior cups) to compare failure rates, safety and use effectiveness

Mola

Kuk

2010

Aust NZ J Obst Gynaeco

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A randomised controlled trial of two instruments for vacuum‐assisted delivery (Vacca Re‐Usable OmniCup and the Bird anterior and posterior cups) to compare failure rates, safety and use effectiveness

Mola

Kuk

2010

Aust NZ J Obst Gynaeco

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“…Our findings imply that increased training and experience for trainee obstetricians is important, especially in light of rising cesarean section rates. Other studies have also recognized a need for improved training in instrumental delivery techniques [28]. While ‘real-life’ experience is desirable, simulator-based training has been developed and may help fulfill some learning needs [29].…”

Section: Commentmentioning

confidence: 99%

Management of fetal malposition in the second stage of labor: a propensity score analysis

Aiken¹,

Aiken²,

Alberry³

et al. 2015

American Journal of Obstetrics and Gynecology

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Objective To determine the factors associated with selection of rotational instrumental versus cesarean delivery to manage persistent fetal malposition, and to assess differences in adverse neonatal and maternal outcomes following delivery by rotational instruments versus cesarean section. Study Design We conducted a retrospective cohort study over a 5-year period in a tertiary UK obstetrics center. 868 women with vertex-presenting, single, live-born infants at term with persistent malposition in the second stage of labor were included. Propensity-score stratification was used to control for selection bias: the possibility that obstetricians may systematically select more difficult cases for cesarean section. Linear and logistic regression models were used to compare maternal and neonatal outcomes for delivery by rotational forceps or ventouse versus cesarean section, adjusting for propensity scores. Results Increased likelihood of rotational instrumental delivery was associated with lower maternal age (OR= 0.95 p<0.01), lower BMI (OR=0.94 p<0.001), lower birth-weight (OR=0.95 p<0.01), no evidence of fetal compromise at the time of delivery (OR=0.31 p<0.001), delivery during the daytime (OR= 1.45, P<0.05), and delivery by a more experienced obstetrician (OR=7.21 p<0.001). Following propensity score stratification, there was no difference by delivery method in the rates of delayed neonatal respiration, reported critical incidents, or low fetal arterial pH. Maternal blood loss was higher in the cesarean group (295.8± 48ml p<0.001). Conclusions Rotational instrumental delivery is often regarded as unsafe. However, we find that neonatal outcomes are no worse once selection bias is accounted for, and that the likelihood of severe obstetric hemorrhage is reduced. More widespread training of obstetricians in rotational instrumental delivery should be considered, particularly in light of rising cesarean section rates.

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“…Correct cup placement (flexing & median) is particularly important in malpositions, when the fetal head faces in a direction other than occipito-anterior [11] [12]. Unfavourable cup applications (deflexing or paramedian) are the commonest cause of failed vacuum delivery, accounting for 40% of failed vacuum deliveries [13]. Not only do trainee obstetricians find correct cup placement a challenge, but they may also fail to recognise when cup placement has been suboptimal.…”

Section: Introductionmentioning

confidence: 99%

“…Not only do trainee obstetricians find correct cup placement a challenge, but they may also fail to recognise when cup placement has been suboptimal. In a 2004 study from the UK, obstetricians recorded their perception of where the vacuum cup had been placed during a vacuum delivery on one form while on a second form a pediatrician indicated the actual site of the cup placement as observed on the baby [13]. The vacuum cup was considered to have been sub optimally sited in 40% of all failed ventouse deliveries.…”

Section: Introductionmentioning

confidence: 99%

Novel Simulation Workshop Improves Performance in Vacuum Delivery

Calvert¹,

Epee²,

Karzcub³

et al. 2016

OJOG

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Background: Operative vaginal delivery is a common obstetric intervention, with the potential to cause harm to mother and baby. Training in operative delivery traditionally comprised junior trainees learning the skills under supervision, then practicing and refining them independently. Recently this model has come under scrutiny, with the advent of simulation-based training suggesting a method by which the skills of safe delivery may be taught without risk. Multiple training courses exist, but few have been subjected to evaluation. Aims: The primary aim was to investigate if a simulation-based training workshop, where the development of a successful technique for vacuum delivery occurs using a collaborative, problem-solving approach, improves the rate of correct vacuum cup placement. The secondary aim was to determine if the workshop leads to improvement in theoretical knowledge of vacuum delivery. Methods: Participants on three workshops were assessed for their performance in vacuum delivery prior to and following a multimodal training program. Participants included general practitioner obstetricians, obstetric trainees and resident medical officers. Evaluation occurred using a standardised Likert-scaled rating sheet and utilising a diagrammatic representation of cup placement. Results: The participants demonstrated significant improvement (median post-pre score 1, p < 0.001) in the accuracy of cup placement, in a variety of practical core skills and in theoretical knowledge of vacuum delivery. Discussion: Participation in a simulation-based vacuum delivery workshop improves the performance of obstetric trainees and GP obstetricians. Further work is required to evaluate the performance of such training modalities on clinically relevant outcomes.

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Vacuum extraction: is there any need to improve the current training in the UK?

Cited by 38 publications

References 11 publications

A randomised controlled trial of two instruments for vacuum‐assisted delivery (Vacca Re‐Usable OmniCup and the Bird anterior and posterior cups) to compare failure rates, safety and use effectiveness

A randomised controlled trial of two instruments for vacuum‐assisted delivery (Vacca Re‐Usable OmniCup and the Bird anterior and posterior cups) to compare failure rates, safety and use effectiveness

Management of fetal malposition in the second stage of labor: a propensity score analysis

Novel Simulation Workshop Improves Performance in Vacuum Delivery

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