MedEdPORTAL (Sep 2015)
Assessment and Management of Spontaneous Preterm Labor
Abstract
Abstract Introduction One of the most significant contributors to neonatal morbidity and mortality is preterm labor and subsequent delivery. For any obstetric provider, this is among the most important diagnostic and management skills to develop quickly so as to minimize the potential for harm to the infant. Proper recognition, interpretation, and management of maternal symptoms, clinical findings, and fetal heart rate tracing are critical skills for the obstetric trainee. This education is traditionally acquired through exposure to lectures, independent study, and case discussion, as well as hands-on clinical experience of labor and delivery. This simulation provides tools to teach medical and nursing students to recognize and develop a management plan for a patient at risk of preterm birth. Methods The student is expected to review in advance either the online didactic session, a summary paper, or both. Reference materials are also provided for students desiring more detailed preparation. During the simulation, the student evaluates and manages preterm birth in a high-fidelity mannequin. The student is unaware of the patient's diagnosis without performing an appropriate history and physical. Immediately after the simulation, the student documents the encounter, and a formal debriefing session is held. Whenever possible, video recordings of the simulations should be made to assist with the debriefing of trainees' technical and communication skills. Advance preparation requires 20-30 minutes, the simulation takes 5-15 minutes, and the debriefing lasts 15-30 minutes. Results The implementation of this curriculum has provided us with the information necessary to educate and train a range of obstetric providers in the evaluation and management of preterm labor using a high-fidelity pregnancy and delivery simulator. Discussion The advent of high-fidelity simulators makes the lifelike simulation of obstetric emergencies such as premature labor possible. The experience allows realistic diagnosis and management in a setting that does not put patients at risk. We believe that the competencies acquired from this training curriculum will generalize to other obstetric emergency care settings.
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