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19 results in ROBuST: RCOG Operative Birth Simulation Training

  • Chapter 2 - Indications and assessment for operative vaginal birth

  • Edited by George Attilakos, Tim Draycott, University of Bristol, Alison Gale, Dimitrios Siassakos, University of Bristol, Cathy Winter
  • Book:
    ROBuST: RCOG Operative Birth Simulation Training
    Published online:
    05 June 2014
    Print publication:
    19 December 2013, pp 12-30

  • Summary

    Operative vaginal births (OVB) have an important role to play in modern obstetric care. OVB should be offered only when the benefits outweigh the potential risks, taking account of both maternal and neonatal perspectives. A systematic clinical assessment, effective communication and expertise in the intended procedure are prerequisites for OVB. OVBs are classified primarily by the station and position of the fetal head. OVB are performed when birth needs to be expedited and may be indicated for conditions of the fetus or the mother or both. Suspected fetal compromise, as revealed by a suspicious or pathological fetal heart rate pattern on cardiotocography (CTG), is also a common indication for OVB. Careful patient assessment, observing the rules of safe obstetric practice and working within the appropriate clinical indications for OVBs should ensure that the benefits of recommending OVB outweigh the risks.

  • Chapter 7 - Caesarean section at full dilatation

  • Edited by George Attilakos, Tim Draycott, University of Bristol, Alison Gale, Dimitrios Siassakos, University of Bristol, Cathy Winter
  • Book:
    ROBuST: RCOG Operative Birth Simulation Training
    Published online:
    05 June 2014
    Print publication:
    19 December 2013, pp 95-109

  • Summary

    Nowadays, concerns regarding operative vaginal birth (OVB) that need to be addressed at a national and institutional level in many countries. This chapter presents general notes on vacuum extraction and forceps to assist vaginal birth. The varying circumstances of practice between countries and hospitals within countries mean that, unless a trainee has opportunities to be trained in a variety of hospitals and regions, it is unlikely that the goals of the RCOG Green-top Guideline on operative vaginal delivery will be attained. One of the purposes of this book, and the ROBuST training course that accompanies it, is to ensure that trainees have the opportunity to develop skills in both methods of OVB. In the developing countries where operative obstetric skills have been maintained, OVB is carried out when there are concerns in terms of 'fit'. Skills training workshops in emergency and newborn care are many and varied too.

  • Chapter 3 - Nontechnical skills

  • Edited by George Attilakos, Tim Draycott, University of Bristol, Alison Gale, Dimitrios Siassakos, University of Bristol, Cathy Winter
  • Book:
    ROBuST: RCOG Operative Birth Simulation Training
    Published online:
    05 June 2014
    Print publication:
    19 December 2013, pp 31-43

  • Summary

    This chapter explains the importance of non-technical skills in obstetric practice. It describes the non-technical skills useful when conducting operative vaginal birth (OVB). Non-technical skills have been studied in surgical, anaesthetic and acute medicine domains using methodology from the aviation industry. OVB merits non-technical skills unique to this very intimate and emotive time for the mother and her birth partner. A three-tier behavioural system is used to classify non-technical skills. The first level has five major categories of these skills. When conducting an OVB, the main categories to be considered are: situational awareness, decision making, team work and communication, professional relationships with the woman, and maintaining professional behaviour. The social and interpersonal skills not only contribute to patient safety but also can lead to a lasting impression on the mother. Therefore, the value of these should not be underestimated and need to be carefully built into teaching and formative assessments.

  • Chapter 6 - Rotational forceps

  • Edited by George Attilakos, Tim Draycott, University of Bristol, Alison Gale, Dimitrios Siassakos, University of Bristol, Cathy Winter
  • Book:
    ROBuST: RCOG Operative Birth Simulation Training
    Published online:
    05 June 2014
    Print publication:
    19 December 2013, pp 83-94

  • Summary

    Rotational forceps are an instrument that every labour ward specialist should be experienced with. Rotational forceps are the instrument par excellence for the occipito-posterior (OP) position. Most cases in which the fetus is found to be in a transverse position are attributable to a failure to rotate, generally as a result of an epidural block that has altered the muscular component of the rotational mechanism. Asynclitism is the oblique presentation of the fetal head in labour, and is important in the context of Kielland's forceps as it is corrected by the sliding lock on the instrument. The modern obstetrician should be able to assess a clinical situation and then decide which instrument is best suited to effect a safe birth. It is essential that Kielland's forceps are used only by obstetricians with the necessary training and experience.

  • Chapter 8 - Medico-legal matters

  • Edited by George Attilakos, Tim Draycott, University of Bristol, Alison Gale, Dimitrios Siassakos, University of Bristol, Cathy Winter
  • Book:
    ROBuST: RCOG Operative Birth Simulation Training
    Published online:
    05 June 2014
    Print publication:
    19 December 2013, pp 110-125

  • Summary

    Operative vaginal births (OVB) have an important role to play in modern obstetric care. OVB should be offered only when the benefits outweigh the potential risks, taking account of both maternal and neonatal perspectives. A systematic clinical assessment, effective communication and expertise in the intended procedure are prerequisites for OVB. OVBs are classified primarily by the station and position of the fetal head. OVB are performed when birth needs to be expedited and may be indicated for conditions of the fetus or the mother or both. Suspected fetal compromise, as revealed by a suspicious or pathological fetal heart rate pattern on cardiotocography (CTG), is also a common indication for OVB. Careful patient assessment, observing the rules of safe obstetric practice and working within the appropriate clinical indications for OVBs should ensure that the benefits of recommending OVB outweigh the risks.

  • Chapter 4 - Vacuum-assisted birth

  • Edited by George Attilakos, Tim Draycott, University of Bristol, Alison Gale, Dimitrios Siassakos, University of Bristol, Cathy Winter
  • Book:
    ROBuST: RCOG Operative Birth Simulation Training
    Published online:
    05 June 2014
    Print publication:
    19 December 2013, pp 44-58

  • Summary

    Vacuum-assisted birth and its acceptance by clinicians will be determined to a large extent by the number of successful births achieved and by the outcomes for the mother and infant. Clinical audits and system analyses often identify deficient knowledge and inadequate operator training as important contributors to adverse outcomes. The design of a vacuum cup is the major factor that determines its manoeuvrability within the lower birth canal and therefore its appropriate clinical use. Vacuum cups that are commercially available include: soft anterior cups, rigid anterior cups, and rigid posterior cups. This chapter describes the five steps of a vacuum-assisted birth: locating the flexion point and calculating the cup-insertion distance, holding and inserting the cup, manoeuvring the cup toward the flexion point, inducing and maintaining the vacuum, and traction method. Recent evidence has demonstrated that midline episiotomy is significantly associated with higher rates of perineal trauma compared with mediolateral episiotomy.

  • Chapter 5 - Nonrotational forceps and manual rotation

  • Edited by George Attilakos, Tim Draycott, University of Bristol, Alison Gale, Dimitrios Siassakos, University of Bristol, Cathy Winter
  • Book:
    ROBuST: RCOG Operative Birth Simulation Training
    Published online:
    05 June 2014
    Print publication:
    19 December 2013, pp 59-82

  • Summary

    Developing skills in non-rotational forceps and manual rotation remains an important element of training in operative obstetrics. The aim of operative vaginal birth (OVB) is to expedite birth for the benefit of the mother, baby or both while minimising maternal and neonatal morbidity. This chapter describes the use of non-rotational forceps in detail and also reviews the technique of manual rotation. Non-rotational forceps are mainly used to facilitate vaginal birth when the fetal head is in an occipito-anterior (OA) position. Forceps are classified according to their design as well as the type of operative birth they are used to perform based on station and position of the fetal head. An alternative to vacuum rotation is manual rotation from occiput transverse (OT) or occiput posterior (OP) positions. Simulation in obstetrics allows training and practice in a safe environment and can improve the performance of individuals and obstetric teams.

  • Chapter 1 - Operative vaginal birth in the 21st century: a global perspective

  • Edited by George Attilakos, Tim Draycott, University of Bristol, Alison Gale, Dimitrios Siassakos, University of Bristol, Cathy Winter
  • Book:
    ROBuST: RCOG Operative Birth Simulation Training
    Published online:
    05 June 2014
    Print publication:
    19 December 2013, pp 1-11

  • Summary

    Nowadays, concerns regarding operative vaginal birth (OVB) that need to be addressed at a national and institutional level in many countries. This chapter presents general notes on vacuum extraction and forceps to assist vaginal birth. The varying circumstances of practice between countries and hospitals within countries mean that, unless a trainee has opportunities to be trained in a variety of hospitals and regions, it is unlikely that the goals of the RCOG Green-top Guideline on operative vaginal delivery will be attained. One of the purposes of this book, and the ROBuST training course that accompanies it, is to ensure that trainees have the opportunity to develop skills in both methods of OVB. In the developing countries where operative obstetric skills have been maintained, OVB is carried out when there are concerns in terms of 'fit'. Skills training workshops in emergency and newborn care are many and varied too.

  • Chapter 9 - Analgesia and anaesthesia for operative vaginal birth

  • Edited by George Attilakos, Tim Draycott, University of Bristol, Alison Gale, Dimitrios Siassakos, University of Bristol, Cathy Winter
  • Book:
    ROBuST: RCOG Operative Birth Simulation Training
    Published online:
    05 June 2014
    Print publication:
    19 December 2013, pp 126-137

  • Summary

    This chapter explains the importance of non-technical skills in obstetric practice. It describes the non-technical skills useful when conducting operative vaginal birth (OVB). Non-technical skills have been studied in surgical, anaesthetic and acute medicine domains using methodology from the aviation industry. OVB merits non-technical skills unique to this very intimate and emotive time for the mother and her birth partner. A three-tier behavioural system is used to classify non-technical skills. The first level has five major categories of these skills. When conducting an OVB, the main categories to be considered are: situational awareness, decision making, team work and communication, professional relationships with the woman, and maintaining professional behaviour. The social and interpersonal skills not only contribute to patient safety but also can lead to a lasting impression on the mother. Therefore, the value of these should not be underestimated and need to be carefully built into teaching and formative assessments.