Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service de Gynécologie Obstétrique, Pierre-Bénite, F-69495, France.
Eur J Obstet Gynecol Reprod Biol. 2011 Dec;159(2):305-9. doi: 10.1016/j.ejogrb.2011.09.002. Epub 2011 Oct 2.
The aim of this study was to evaluate whether forceps training on a birth simulator allows obstetricians to improve forceps blade placement.
Analysis was based on 600 forceps blade placements performed by ten trainees on a simulator. The trajectories used by the trainees were assessed using reference spheres that reflected an optimal bimalar placement. Three definitions of success were used: small-sphere success, medium-sphere success and large-sphere success were respectively defined by the forceps blade tip being within 5, 10 or 15mm of the center of the sphere (the small-sphere being nested within the medium-sphere and the small and medium being nested within the large-sphere). Wilcoxon paired analysis was performed to compare the first (50 trajectories) and final (50 trajectories) sets of five forceps placements. Graphical representation and linear regression were used to visualize the learning process.
596 trajectories were available for analysis. During the last set of five forceps the success rate was respectively 28%, 72% and 86% for small-sphere, medium-sphere and large-sphere success with the right blade and 8%, 32% and 70% for the left blade. Wilcoxon analysis showed a highly significant improvement for all kinds of success in the right blade and for large-sphere success in the left blade. Linear regression slopes were significant. Using a projection, the theoretical numbers of placements needed to achieve a 100% success rate for small-sphere, medium-sphere and large-sphere were respectively 80, 45 and 35.
These results strongly suggest that performing forceps blade placement on birth simulator allows obstetricians to improve their skills.
本研究旨在评估产钳训练器是否能使产科医生改善产钳叶片的放置位置。
该分析基于 10 名学员在模拟器上进行的 600 次产钳叶片放置。学员使用的轨迹通过反映最佳双叶放置的参考球体进行评估。使用了三种成功定义：小球体成功、中球体成功和大球体成功分别定义为产钳叶片尖端距离球体中心 5、10 或 15mm 以内（小球体嵌套在中球体中，小球体和中球体嵌套在大球体中）。使用 Wilcoxon 配对分析比较前 50 次（50 次轨迹）和最后 50 次（50 次轨迹）的 5 次产钳放置。图形表示和线性回归用于可视化学习过程。
可分析的轨迹有 596 条。在最后一组 5 次产钳中，右叶片的小球体、中球体和大球体成功率分别为 28%、72%和 86%，左叶片分别为 8%、32%和 70%。Wilcoxon 分析显示，所有类型的成功都有显著提高，右叶片的大球体成功率也有显著提高。线性回归斜率具有统计学意义。通过投影，理论上要达到 100%的小球体、中球体和大球体成功率，需要分别进行 80、45 和 35 次放置。
这些结果强烈表明，在分娩模拟器上进行产钳叶片放置可以使产科医生提高技能。
