One out of ten deliveries are complicated by postpartum hemorrhage (PPH) with an associated maternal mortality rate as high as 17%. The most common cause of PPH is uterine atony. Uterine atony, or failure of the myometrial muscle fibers to contract following delivery, can lead to rapid and severe hemorrhage and hypovolemic shock. The effective management of major PPH relies on an organized multidisciplinary approach involving the obstetrician, anesthesiologist, hematologist, nursing staff, laboratory, and blood bank personnel. This simulation was been designed to provide an opportunity for anesthesia and OB/GYN residents to practice the diagnosis and management of an obstetric bleeding emergency in a realistic, but risk-free environment. This simulation scenario has been implemented successfully in our simulation curriculum at University of Washington ISIS Simulation Center. It is best run in a standard simulation center with a high-fidelity mannekin (Laerdal SimMan). The simulation takes two hours to complete and works best with three-to five-learners per session. Participants at the institution, first-, second-, and third-year clinical anesthesia residents, acknowledged the realism and value of the experience in their feedback. Perceived benefits included optimization of clinical performance and decision-making during crisis management, and a sharpening communication skills while interacting with a multidisciplinary team.
By the end of this module, the learner will be able to:
- Initiate a sequence of medical and resuscitative interventions for control of postpartum hemorrhage, and promptly assess the success and failure of each measure.
- Understand the concept of crisis resource management.
- Demonstrate advanced clinical and technical skills in delivering anesthetics for obstetrics and managing major OB bleeding.
© 2011 Metzner et al.
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Metzner J, Reid J, Wu C, et al. Obstetric bleeding curriculum. MedEdPORTAL. 2011;7:8305. https:/
doi. org/ 10. 15766/ mep_ 2374- 8265. 8305