19
Experimental
&
Clinical Article
1
Necmettin Erbakan University, Meram Faculty of Medicine, Department of
Gynecology and Obstetrics, Konya, Türkiye
2
Necmettin Erbakan University, Meram Faculty of Medicine, Department of
Family Medicine, Konya, Türkiye
Address of Correspondence: Nur Demirbas
Necmettin Erbakan University, Meram
Faculty of Medicine, Department of Family
Medicine, Konya, Türkiye
ndemirbas76@hotmail.com
Submitted for Publication: 14.02.2022 Revised for Publication: 14.02.2022
Accepted for Publication: 30.08.2022 Online Published: 16.09.2022
ORCID IDs of the authors: JEH: 0000-0002-8738-7126
ND: 0000-0002-4038-9386 SC: 0000-0003-3825-3559
Gynecol Obstet Reprod Med 2023;29(1):19-26
How to cite this article: Horasanli JE. Demirbas N. Cicek S. Obstetric
Simulation Training to Breech Delivery, Shoulder Dystocia, Forceps, and
Vacuum Experience. Gynecol Obstet Reprod Med. 2023;29(1):19-26
Quick Response Code: Access this article online
Website: www.gorm.com.tr
e- mail: info@gorm.com.tr
DOI:10.21613/GORM.2022.1298
pensation payments. Shoulder dystocia complicates 2% of all
vaginal deliveries and can cause significant long-term compli-
cations, including permanent brachial plexus injury, clavicle
fracture, hypoxic brain injury, and neonatal death (1,2).
Therefore, managing shoulder dystocia is a critical skill that
must be taught during specialization training. Medical simula-
tion is a relatively new field and has been well suited for emer-
gencies such as shoulder dystocia (3).
It was determined that 15% of all deliveries are vaginal op-
erative delivery (4). Forceps, and to a lesser extent, the vac-
uum application, are used for vaginal operative delivery (5).
Although the vacuum application may seem more practical, it
requires training and attention to prevent maternal and infant
harm (6). Simulation training enables these skills to be learned
since there is no risk for the patient or fetus (3).
Delays in diagnosis and therapeutic intervention, a lack of
information, miscommunication, and poor teamwork lead to
adverse events (4). It was stated that simulation methodolo-
gies, which are increasingly used in the world and aim at stu-
dent-centered education, arise from an ethical obligation in
order not to harm the patient, and it was also emphasized that
Copyright
©
2023. Horasanli et al. This article is distributed under a Creative Commons Attribution 4.0 International License.
Obstetric Simulation Training to Breech Delivery, Shoulder Dystocia,
Forceps, and Vacuum Experience
Jule Eric HORASANLI
1
, Nur DEMIRBAS
2
, Seyma CICEK
1
Konya, Türkiye
ABSTRACT
OBJECTIVES: This study aimed to create a simulation model in shoulder dystocia, breech delivery, and
vacuum forceps applications, and to show the effect of education on the knowledge-skill level of the in-
dividuals involved.
STUDY DESIGN: This prospective cohort research was conducted among assistant doctors and mid-
wives. The course was held in the simulation center by creating 4 different scenarios. The steps of each
maneuver were determined separately. Performance was evaluated on a five-point Likert-type scale be-
tween 1-5 points before and after training. A higher score was considered higher proficiency in the sub-
ject.
RESULTS: Of the participants in the study, 51.4% (n=19) of 37 were doctors. The post-training scores
obtained from each step of the shoulder dystocia maneuvers, breech birth maneuver, forceps applica-
tion, and vacuum application were statistically significantly higher than the pre-training scores (p<0.001).
The change in the post-training skill scores of the physicians was significantly higher than that of the
midwives (p<0.001). Post-training, 67.9% of the participants thought that the simulation training was a
great help in transforming their theoretical knowledge into practice.
CONCLUSION: Breech delivery, shoulder dystocia, forceps, and vacuum applications are difficult sub-
jects to education in obstetrics. In these pieces of training, simulation should be used as a training
method in obstetric education and integrated into the curriculum. We believe that giving and dissemi-
nating an effective and accessible simulation protocol to healthcare professionals can reduce birth com-
plications.
Keywords: Breech delivery, Education, Forceps, Shoulder dystocia, Simulation, Vacuum
Obstetrics; Maternal-Fetal Medicine and Perinatology
Introduction
Obstetrics is one of many health specialties focused on re-
ducing medical errors and adverse events. Obstetric complica-
tions, malpractice, and their consequences cause high com-