Deficits in the provision of cardiopulmonary resuscitation during simulated obstetric crises
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
2010; 203 (2)
Use of Simulation Based Team Training for Obstetric Crises in Resident Education
SIMULATION IN HEALTHCARE
2008; 3 (3): 154-160
Previous work suggests the potential for suboptimal cardiopulmonary resuscitation (CPR) in the parturient but did not directly assess actual performance.We evaluated 18 videotaped simulations of maternal amniotic fluid embolus and resultant cardiac arrest. A checklist containing 10 current American Heart Association recommendations for advanced cardiac life support (ACLS) in obstetric patients was utilized. We evaluated which tasks were completed correctly and the time required to perform key actions.Proper compressions were delivered by our teams 56% of the time and ventilations 50% of the time. Critical interventions such as left uterine displacement and placing a firm back support prior to compressions were frequently neglected (in 44% and 22% of cases, respectively). The mean +/- SD overall composite score for the tasks was 45 +/- 12% (range, 20-60%). The neonatal team was called in a median (interquartile range) of 1:42 (0:44-2:18) minutes:seconds; 15 of 18 (83%) teams called only after the patient was completely unresponsive. Fifty percent of teams did not provide basic information to the neonatal teams as required by neonatal resuscitation provider guidelines.Multiple deficits were noted in the provision of CPR to parturients during simulated arrests, despite current ACLS certification for all participants. Current requirements for ACLS certification and training for obstetric staff may require revision.
View details for DOI 10.1016/j.ajog.2010.02.022
View details for Web of Science ID 000280234500037
View details for PubMedID 20417476
PERIPARTUM MATERNAL CARDIOMYOPATHY WITH IDIOPATHIC CARDIOMYOPATHY IN THE OFFSPRING - A CASE-REPORT
JOURNAL OF REPRODUCTIVE MEDICINE
1986; 31 (12): 1109-1112
Obstetric crises are unexpected and random. Traditionally, medical training for these acute events has included lectures combined with arbitrary clinical experiences. This educational paradigm has inherent limitations. During actual crises insufficient time exists for discussion and analysis of patient care. Our objective was to create a simulation program to fill this experiential gap.Ten L&D teams participated in high fidelity simulation training. A team consisted of two or three nurses, one anesthesia resident and one or two obstetric residents. Each team participated in two scenarios; epidural-induced hypotension followed by an amniotic fluid embolism. Each simulation was followed by a facilitated debriefing. All simulations were videotaped. Clinical performances of the obstetric residents were graded by two reviewers using the videotapes and a faculty-developed checklist. Recurrent errors were analyzed and graded using Health Failure Modes Effects Analysis. All team members completed a course evaluation.Performance deficiencies of the obstetric residents were identified by an expert team of reviewers. From this list of errors, the "most valuable lessons" requiring further focused teaching were identified and included 1) Poor communication with the pediatric team, 2) Not assuming a leadership role during the code, 3) Poor distribution of workload, and 4) Lack of proper use of low/outlet forceps. Participants reported the simulation course allowed them to learn new skills needed by teams during a crisis.Simulated obstetric crises training offers the opportunity for educators to identify specific performance deficits of their residents and the subsequent development of teaching modules to address these weaknesses.
View details for DOI 10.1097/SIH.0b013e31818187d9
View details for Web of Science ID 000207536200005
View details for PubMedID 19088659
ADRENALECTOMY-INDUCED DEFICITS IN MATERNAL RETRIEVAL IN RAT
HORMONES AND BEHAVIOR
1977; 9 (3): 222-227
Peripartum cardiomyopathy is an enigmatic disorder. A patient who developed it after delivery had a twin pregnancy complicated by demise of one fetus, preterm labor and subsequent preterm delivery of the viable twin, who died at 48 hours of life. The second twin had autopsy evidence of idiopathic cardiomyopathy, as did a prior child, who had died at 2 years of age. This report is the first on a woman with peripartum cardiomyopathy associated with idiopathic cardiomyopathy in her live-born infant. Our findings, in conjunction with those noted in a review of the literature, suggest that there is a subset of peripartum cardiomyopathy that may be mediated on a genetic or immunologic basis.
View details for Web of Science ID A1986F204800008
View details for PubMedID 3795199