Obstetric Decision-Making and Simulation

Simulation is becoming an integral part of medical education and has already a well-established role within anaesthesia training, with many examination questions already modelled on simulation scenarios. The clinical diversity and multidisciplinary nature of an obstetric team creates the ideal environment for simulation training. It enables the team to develop their knowledge of clinical emergencies whilst becoming more aware of the importance of human factors. This book is a practical guide to inspire clinical leads to establish simulation within their delivery suite. The book comprises an extensive obstetric scenario library, with each scenario broken down into learning outcomes, a list of staff and equipment needed, specific stages mapped to learning outcomes with appropriate results/investigations and a checklist of ideal actions to enable the post-scenario debrief. Written by consultant obstetric anaesthetists, this book will appeal to medical practitioners interested in facilitating obstetric simulation.

    Features a comprehensive obstetric simulation scenario library which will allow both experienced and inexperienced facilitators of simulations to easily prepare for and run simulation drills
    Offers a rapid access guide with a clear consistent layout and concise discussion following each scenario
    Covers both the theory and practical aspects of facilitating simulation

Table of Contents

List of Contributors
Foreword
Part I. The Role of Simulation:
1. Setting the scene for simulation-based education Debra Nestel, Kristen Moloney and Simon Hyde
2. The where of simulation training Al May
3. Interprofessional in-situ simulation Jonathan Hurst
4. Debriefing and the debrief Mark Murphy and Annemarie Brown
5. Fidelity in obstetric simulation Shane O'Sullivan and Owen O'Sullivan
Part II. The Impact of Human Factors in Clinical Practice:
6. Introduction to human factors and ergonomics in obstetric simulation Mark Hellaby
7. Situational awareness, bias and decision making styles in obstetric simulation Ian Parkinson and Andrew F. Smith
8. Team-working, communication and use of communication aids and checklists in an emergency Simon Mercer
Part III. Clinical Scenarios:
9. Introduction to the scenarios Kirsty Maclennan
Scenario Section 1: Obstetric
10. Uterine inversion Samantha Bonner
11. Shoulder dystocia following forceps delivery for fetal bradycardia Samantha Cox and Samiksha Patel
12. Umbilical cord prolapse Michelle McIntosh
13. Minimising decision to delivery interval (DDI) in a category 1 caesarean section – pre-theatre phase Cliff Shelton and Sophie Bishop
Scenario Section 2: Maternal collapse
14. Amniotic fluid embolism Kim Macleod and Yara Mohammed
15. Anaphylaxis in labour Andrew Parkes and Shuayb Elkhalifa
16. Acute pulmonary embolism in pregnancy Louise Simcox and David Simcox
Scenario Section 3: Haemorrhage
17. Antepartum haemorrhage and perimortem caesarean section Kenneth Ma
18. Vasa praevia Shimma Rehman
19. Postpartum haemorrhage Pavan Kochhar and Stuart Knowles
Scenario Section 4: Sepsis
20. Group A streptococcal puerperal sepsis Laura Coleman and Melissa Whitworth
21. Pneumonia and respiratory failure in a pregnant woman James Hanison and Dougal Atkinson
Scenario Section 5: Hypertensive disorders of pregnancy
22. Eclampsia Stephanie Worton, Emma Shawkat and Jenny Myers
23. HELLP syndrome with fetal compromise requiring an emergency GA caesarean section Emma Shawkat, Stephanie Worton and Jenny Myers
24. Microangiopathic haemolytic anaemia (MAHA) in pregnancy presenting in A&E Louise Simcox and Jo Gillham
Scenario Section 6: Cardiac
25. Chest pain in a pregnant patient Shahid Karim and Sarah Vause
26. Peripartum cardiomyopathy Omar Asghar and Sarah Vause
27. Complete heart block in a pregnant patient Anita Macnab and Kirsty Maclennan
28. Cardioversion in a pregnant patient with corrected tetralogy of fallot Kailash Bhatia
Scenario Section 7: General anaesthesia
29. General anaesthesia and failed intubation in a category 1 caesarean section Richard McGuire and Sharon Smith
Scenario Section 8: Neuraxial analgesia
30. Subdural block in labour Kathryn A. Wood and Lorna A. Howie
31. Total spinal anaesthesia in labour K. E. Gott and Sophie Kimber-Craig
32. Severe local anaesthetic toxicity in labour Charlotte Ash and Suna Monaghan
Scenario Section 9: Non-neuraxial analgesia
33. Respiratory arrest in a woman using remifentanil PCA for labour Michael McGinlay and Susan Davies
Scenario Section 10: Endocrine
34. Diabetic ketoacidosis in pregnancy Samantha Bonner and Jonathan Schofield
Scenario Section 11: Neurological
35. Subarachnoid haemorrhage in the post partum patient Craig Carroll and Daniel Holsgrove
Scenario Section 12: Trauma
36. Obstetric trauma John Butler
Scenario Section 13: Neonatal
37. Newborn life support (preterm delivery) in obstetric anaesthesia Jonathan Hurst
Index.

Kirsty Maclennan is a consultant in general and obstetric anaesthesia. She is Associate Director of Medical Education and Simulation Faculty Chair at Manchester Foundation Trust and is Training Programme Director for Core Anaesthesia Manchester South. Her previous written works include Core Topics in Obstetric Anaesthesia (Cambridge, 2015).

Catherine Robinson is a general and obstetric anaesthetist. She is very active in medical education, training all members of the multidisciplinary obstetric team including midwives, critical care nurses, obstetricians and anaesthetists. She is a human factor and simulation enthusiast, who promotes and facilitates simulation training.