A76 A Hands-On Approach: Improving Trainee Confidence in Uterine Inversion and Postpartum Haemorrhage Management Through Low-Cost Simulation
Notice bibliographique
Résumé
Introduction: Uterine inversion is a rare but life-threatening obstetric emergency, with its precise incidence remaining unclear [1]. A Canadian case series by Baskett suggests an incidence of 1 in 3,127 deliveries [2]. Associated with considerable morbidity and mortality, prompt recognition and management are essential to improving maternal outcomes [1]. Given its rarity, exposure to this emergency may not occur until later stages of clinical training. We aimed to develop a skills-based session using low-cost simulation models to support obstetric trainees in managing acute uterine inversion and associated postpartum haemorrhage (PPH). Methods: Four handmade uterine models were constructed from a mixture of felt, thread, velcro, cardboard, and wool. They represented key scenarios: inversion with adherent placenta, manual removal of placenta (MROP), atonic uterus for balloon tamponade, and a softly stuffed uterus for brace suture placement. Each model was integrated into a part-task pelvic trainer and used in a one-hour simulation session as part of an obstetric emergencies training day. Trainees (ST1–ST7) participated in small groups, facilitated by a registrar and consultant Obstetrician. The session included deliberate practice, structured discussions, and additional learning materials. Trainees completed all steps of uterine inversion management, MROP, and surgical control of PPH. Results: Feedback was obtained from 15 participants (n=15). 93.3% (n=14/15) rated the uterine inversion and MROP session as excellent and appropriate to their training level. Confidence levels, measured on a 5-point Likert scale (1= not at all confident to 5 = completely confident), increased from a pre-session mean of 3.1 to 4.2 following the session. Post-session, 87% (n=13/15) reported being fairly or completely confident, compared to 40% (n=6/15) beforehand. Similarly, 80% (n=12/15) rated the PPH surgical skills component as excellent and suitable for their training level. Confidence levels rose from a mean of 2.9 pre-session to 4.1 post-session, with 80% (n=12/15) feeling fairly or completely confident post-session, again up from 40% (n=6/15). Discussion: This low-cost, low-fidelity simulation, supported by expert facilitation, enabled participants to practice the management of a rare but critical emergency using a stepwise approach. Trainees across all grades reported improved confidence. While effective, the fabric models limited hydrostatic demonstration of the O’Sullivan technique. Future versions of the models will include enhanced anatomical features such as vasculature and adnexa to better simulate surgical procedures, including Huntington’s manoeuvre and emergency hysterectomy. Overall, this session achieved its educational objectives, was well received, and offers a reproducible model for future training. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable. References 1. Bhalla R, Wuntakal R, Odejinmi F, Khan RU. Acute inversion of the uterus. The Obstetrician & Gynaecologist. 2009;11:13–18. Available from: https://obgyn.onlinelibrary.wiley.com/doi/10.1576/toag.11.1.13.27463#b6 2. Baskett TF. Acute uterine inversion: a review of 40 cases. J Obstet Gynaecol Can. 2002;24(12):953–956. Available from: https://pubmed.ncbi.nlm.nih.gov/12464994/
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,010 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,003 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,012 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».