A Simple and Practical Amniocentesis Model and the Procedure Success Rate After Training

Objective: To compare success rate of amniocentesis between model trained and non-model trained groups. Methods: Siriraj amniocentesis simulator was practiced by 5 inexperienced obstetric residents. Forty aspirations of red solution from the targeted balloons using spinal needle number 20-G under the ultrasound guidance were performed. Thereafter, each trainee was allowed to perform the real amniocentesis under an expert supervision within a 5-minute period. Amniocentesis success rate of previous 5 non-model trained residents was retrospectively reviewed and considered as the control group. Results: A comparison between each group was done to evaluate the success rate. There were 31 and 29 of amniocenteses performed by model trained and non-model trained groups, respectively. In comparison, the former had a non-significantly higher success rate (96.8% vs 82.2%; p > 0.05) with a significantly shorter operating time (34.27 ± 21.7 vs 73.38 ± 68.5 seconds; p < 0.05) than the latter. No obstetric adverse outcome was observed in both groups. Conclusion: The amniocentesis-training program with model is beneficial for the beginners to develop their skill prior to the real practice, especially shorter operating time. There was a trend of higher success rate in the model- training group

Comparison of maternal and perinatal morbidity between elective and emergency caesarean section in singleton-term breech presentation

The objective of the study was to compare maternal and neonatal adverse outcomes between elective caesarean section (ElCS) and emergency caesarean section (EmCS) for singleton-term breech presentation. This study included women with singleton breech presentation who underwent ElCS or EmCS at term during 2007–2015 at Siriraj Hospital (Thailand). Complete data were collected for 2178 pregnant women. Of those, 1322 (60.7%) women underwent EmCS, and 856 (39.3%) delivered by ElCS. Maternal and perinatal morbidity were compared. There was no maternal or perinatal death in either group. Maternal morbidity was comparable between groups, except for longer hospital stay in the EmCS group (p = .047). One-minute Apgar score was significantly lower in the EmCS group (p = .040). There was no significant difference in 5-min Apgar score between groups. No significant difference was observed for serious maternal and neonatal morbidity between women who underwent ElCS versus those who underwent EmCS for singleton-term breech presentation.IMPACT STATEMENT What is already known on this subject? Emergency caesarean section (EmCS) is generally known to be associated with a higher risk of maternal and neonatal complications than elective caesarean section (ElCS). What do the results of this study add? In singleton-term breech presentation, EmCS in tertiary care setting was not associated with an increase in serious maternal and neonatal morbidity compared with EICS. Cord prolapse as an indication for emergency caesarean section was significantly associated with adverse outcomes while advanced cervical dilation ≥7 cm or low foetal station ≥+1 did not have an impact on maternal and neonatal complications. What are the implications of these findings for clinical practice and/or further research? Mean gestational age in both the ElCS and EmCS groups was approximately 38 weeks and 5 d; there were no neonatal cases with respiratory distress syndrome. Our findings suggest further prospective study in planned caesarean section scheduled for 38–39 weeks in patients with term breech presentation. The results of such a study could yield lower rates of both EmCS and potential adverse outcomes

The efficacy of postpartum tubal sterilization training program with minilaparotomy approach in Ob/Gyn residents

Objectives: To evaluate the efficacy of postpartum tubal sterilization training program with minilaparotomy approach (PTSMA). Study design: From September 2020 to November 2021, 24 first-year Obstetrics and Gynecology (Ob/Gyn) residents were randomly allocated into 2 groups of traditional apprenticeship learning (watching video clip) versus apprenticeship learning plus PTSMA attending. The program consisted of didactics followed by self-practicing with 2 stations of postpartum tubal sterilization simulators (PTSS). All participants were allowed to perform their first tubal sterilization under supervision within a few days after training. Their surgical skills were blindly evaluated by 2 experts through the recorded videos. Five domains of direct observation of procedural skills (DOPS) score introduced by Royal Thai College of Obstetricians and Gynecologists were assessed. DOPS score, operative time, blood loss and post-op complication were analyzed and compared. Results: Median of total DOPS score in the PTSMA group was higher than the non-PTSMA group (93 vs. 73, p = 0.020). Concerning 2 domains of DOPS score (tubal fishing and tubal sterilization), the PTSMA group had the higher median score than the non-PTSMA group (36 vs. 24, p = 0.045 and 40 vs. 32, p = 0.020). There was no significant difference observed in the median score of 3 other domains (peritoneal cavity accessing, abdominal wall closure and complication prevention), estimated blood loss and operative time. Conclusion: Postpartum tubal sterilization training program with minilaparotomy approach using instructive simulators significantly improved the total DOPS score especially tubal fishing and tubal ligation skills in Ob/Gyn residents. Implications: The study evidently showed the benefit of PTSMA with an inexpensive and simple to prepare models. In unexperienced operators, practicing in model prior to surgery should be encouraged to improve their operative skills