Development and use of mechanical devices for simulation of seizure and hemorrhage in obstetrical team training.
BACKGROUND
The leading causes of pregnancy-related death are embolism (20%), hemorrhage (17%), and pregnancy-induced hypertension (16%).The Obstetric and Mechanical Engineering Departments at Stanford University worked together to create inexpensive devices that were used in high fidelity simulations to replicate 2 of the leading causes of maternal mortality: hemorrhage and eclampsia (seizure).


METHODS
The mechanisms were designed to behave as similarly as possible to a human patient. The engineering team designed the eclampsia mechanism to jostle the mannequin's head at a frequency and randomness that matched those observed in human generalized seizures. The hemorrhage mechanism was designed to give visual and tactile cues similar to the actual physiology of a pregnant uterus. Both devices were remote controlled.


RESULTS
The hemorrhage mechanism was used in a scenario of an amniotic fluid embolism with severe postpartum hemorrhage. The final flow rate was adjustable between 525 and 600 mL/min. The trainees' rapid response and control of the postpartum hemorrhage was deemed to be a vital part of a successful maternal resuscitation. The seizure mechanism was used in a simulation of a pregnant woman in labor with evidence of severe preeclampsia. If the trainees did not recognize the need for treatment of the preeclampsia, the patient simulator had a 45- to 60-second seizure. If corrective actions were not taken, another seizure occurred.


CONCLUSIONS
The use of remote controlled mechanical devices designed to accurately replicate the visual, auditory, and tactile cues of hemorrhage and eclampsia enhanced high fidelity simulation training in obstetrical emergencies.
Daniels
Kay
K
Department of Obstetrics and Gynecology, Stanford University, Stanford, California 94305, USA. k.daniels@stanford.edu
Parness
Aaron J
AJ
D003198:Computer Simulation; D004461:Eclampsia / Q000628:therapy*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008348:Manikins; D009773:Obstetric Nursing / Q000193:education*; D009774:Obstetrics / Q000193:education*; D010348:Patient Care Team / Q000592:standards*; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D012371:Robotics / Q000295:instrumentation* / Q000379:methods