Best practice & research. Clinical obstetrics & gynaecology
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Best Pract Res Clin Obstet Gynaecol · Dec 2010
Training and assessment in obstetrics: the role of simulation.
Simulation is becoming an integral part of the training and assessment of obstetricians. Given the variety of manual skills that must be learned, awake patients and high-risk environment, obstetrics is uniquely suited for simulation. Simulation provides opportunities to rehearse and learn from mistakes without risks to patients. ⋯ Basic and advanced skills as well as the management of obstetric emergencies are amenable to simulation. For a simulation programme to be successful, one must identify the learner and the skills that are to be learned. In the future, simulation will be more available and realistic and will be used not only for education, but also for ongoing assessment of providers.
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Best Pract Res Clin Obstet Gynaecol · Dec 2010
Training and assessment in gynaecologic surgery: the role of simulation.
The paradigm of surgical education is changing. Surgical residencies are now required to have skills laboratories so that varying degrees of surgical training and skills acquisition can occur outside of the operating room. There is mounting evidence that surgeons can learn many fundamental skills and specific procedures with simulators. ⋯ Less-expensive models are often as effective for training as low-fidelity models. Developing an effective surgical simulation programme requires a commitment to the concept and finding the time and space. Most importantly, it requires desire on the part of the trainees to devote the hours of practise needed to make themselves accomplished surgeons.
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Best Pract Res Clin Obstet Gynaecol · Jun 2010
Review Comparative StudyThe effects of maternal labour analgesia on the fetus.
Maternal labour pain and stress are associated with progressive fetal metabolic acidosis. Systemic opioid analgesia does little to mitigate this stress, but opioids readily cross the placenta and cause fetal-neonatal depression and impair breast feeding. Pethidine remains the most widely used, but alternatives, with the possible exception of remifentanil, have little more to offer. ⋯ Actual neonatal outcome, however, suggests that benefits outweigh detrimental influences. Meta-analysis demonstrates that Apgar score is better after epidural than systemic opioid analgesia, while neonatal acid-base balance is improved by epidural compared to systemic analgesia and even compared to no analgesia. Successful breast feeding is dependent on many factors, therefore randomized trials are required to elucidate the effect of labour analgesia.
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Best Pract Res Clin Obstet Gynaecol · Jun 2010
ReviewNerve injuries after neuraxial anaesthesia and their medicolegal implications.
Serious and permanent neurologic complications in the obstetric population are rare. Most neurologic complications following childbirth are intrinsic obstetric palsies. The most common intrinsic obstetric palsy is lateral femoral neuropathy. ⋯ Postpartum complaints should be addressed promptly. For infection and space-occupying lesions of the neuraxial canal, prompt diagnosis and treatment are essential to prevent permanent injury or death. Survey studies have demonstrated that women want to be told of the risks of neuraxial procedures, even when the incidence is rare.