Evaluation On The Effect Of Simulation Training Of Obstetric Vaginal Delivery

BackgroundCesarean section is an important method to solve abnormal delivery in obstetrics and gynecology,.However,in recent years,the rate of cesarean section in our countrycontinue to rise,and the rate of cesarean section in some hospitals reached 70%,greatly exceeded the 15%standard set by the World Health Organization and become a serious public health problem[1].Although cesarean section has been widely used to solve abnormal childbirth and significantly reduced neonatal mortality,due to the lack of mechanical birth canal compression and other factors,the incidence of respiratory complications such as amniotic fluid inhalation,wet lung,atelectasis and other respiratory complications of cesarean delivery is much higher than that of vaginal delivery[2].Cesarean section can cause chronic abdominal pain,menstrual disorders,ectopic pregnancy,periuterine tissue adhesion,injury,infection,bleeding and other near and long-term complications,which lead toinfluence on women's health.In recent years,with the change of China's family planning policy,the opening of the second child policy and the popularization and application of the new labor process standard in China,how to reduce the first cesarean section rate and increase vaginal delivery rate become a serious problems facing obstetricians in our country[3]Vaginal midwifery is a reasonable choice to reduce the rate of cesarean section and increase the rate of vaginal delivery.The ability of a mother to successfully perform the natural delivery is closely related to midwifery skills of obstetric nurses,which include the skillful skills of the operator,to avoid the serious complications of mother and child.Vaginal midwifery includes forceps midwifery and fetal head suction.When abnormal labor process occurs in the course of delivery or emergency delivery is needed,grasping the surgical indication of vaginal midwifery,mastering the operation skills and complications of mother and child,correctly choosing the operation method,can make the parturient and fetus get out of danger quickly,ensure the safety of delivery and reduce the injury of mother and child.Vaginal midwifery,such as forceps and fetal head suction,is an important midwifery technique to deal with the second stage of labor,must be a basic skill for all obstetric medical personnel.In 2002,two large-scale multi-center studies have reported that the utilization rate of fetal head suction was 3.3%,and that of forceps was 1.9%.But,the rate in 2011 was 1.107%[3-4].So,it is of great importance to strengthen the training and promotion of vaginal midwifery technology.ObjectiveTo analyze the changes of vaginal midwifery rate,cesarean section rate and maternal and child outcome in the maternal and child health hospital of Henan province before and after the 4 years of obstetric vaginal midwifery simulation training from 2015 to 2019,for the purpose to improve the technique of vaginal midwifery and reduce the rate of cesarean section.the effects of Kirkpatrick's Model on the training effect of the training and the clinical indexes of the parturient and newborn during the study period were evaluated.Finally,the theoretical knowledge of the training,the influence of the abnormal labor process or the emergency delivery ability and the changes of the maternal and infant outcomes were discussed.Material and Methods1.Training targetThe hospital medical staff,including obstetricians and midwives,who received the obstetric vaginal surgery midwifery simulation training at the third affiliated hospital of Zhengzhou University in 2017.4.1-2019.3.31.Inclusion criteria:On-the-job obstetricians and midwives who have passed the examination after taking the theoretical and operational training and complete data;Exclusion criteria:Those who have not completed the course or examinations,tutors and personnel involved in the pilot design.The total number of participants in the training was 117,with 5 excluded from incomplete information and eventually 112 multidisciplinary personnel.Collect general information on subjects such as:gender,age,highest academic qualifications,title,section,working years and course preparation time(see Schedule 1)?2.Research subjectsCollecting and summarizing 52552 cases of maternal delivery in the maternity and child care hospital of Henan Province in 2015.3.1-2019.3.31,we divided the research into two phases according to the time of carrying out the training of vaginal operation midwifery:the first stage(before training):2015.3.1-2017.2.28 a total of 25550 cases was include,and the training time was in March 2017,the second tage(after training):2017.4.1-2019.3.31 A total of 27002cases was include.3.Exclusion criteria(1)Absence or make-up examination.(2)Maternal:1 without follow-up.2.Those with contraindications for vaginal surgery delivery such as:non-parsial or face-first exposure;fetal orientation or fetal head level is unclear;fetal head is not connected;uterine orifice is not fully opened;head and pelvis is not weighed;fetal coagulation dysfunction(hemophilia,isoimmune thrombocytopenia);fetal osteogenesis is not complete;fetal head position is not good;fetal head rotation>45°to properly place a forceps or a fetal head attractor for midwifery[5].4.Observation indicatorsTo analyze the maternal and infant conditions,such as vaginal midwifery rate,cesarean section rate and perineum ? degree laceration rate,neonatal asphyxia rate before training from April 1,2017 to March 31,2019 and after training from March 1,2015 to February 28,2017.And analyze the change of vaginal midwifery rate,cesarean section rate,incidence of perineal ? degree laceration,neonatal asphyxia rate and so on after training in 2017-2019.5.Statistical methodsSPSS22.0 software was used for statistical analysis,the counting data were expressed in%,and the X2 test was used,P<0.05 was statistically significant.ResultsSatisfaction survey results:through a comprehensive and in-depth survey,85.71%of trainees said that the course content provided in the training process was rigorous and correct,80.36%of the trainees said that the tutors are professional in all aspects and have strong teaching ability,and pay attention to the teaching methods in the training.65.17%said that the simulation scenes provided are very lifelike,95.54%said that the course content and reality fit,and the training efforts should be increased.84.82%of the trainees said that through the training,the theoretical basis has been effectively consolidated,and the skill level has also been improved.After receiving the rigorous and standardized training,the theoretical performance,operation level and cooperation ability of the trainees were significantly improved(P<0.05).Through the currently widely used spearson correlation analysis method,the relationship between the general situation and the performance of the students was objectively and comprehensively clarified.Through the analysis,it was found that there was a significant positive correlation between the theoretical performance and the preview time(P<0.05),and there was a significant positive correlation between the performance of the students and the factors such as working age and age(P<0.05).3.The rate of cesarean section after training(April 1,2017 to March 31,2019)was significantly lower than that before training(March 1,2015 to February 28,2017),while the rate of forceps delivery and vaginal operation delivery was higher than that before training(P<0.05).4.Vaginal midwifery conductions after-training:after carrying out vaginal midwifery simulation training,the midwifery rate was continuously improved,the cesarean section rate was continuously reduced,and the perineal ? degree laceration rate of the parturient was also significantly reduced.Vaginal midwifery increased significantly from 0.61%in 2015.3.1?2017.2.28 to 2.32%in 2017.4.1?2019.3.31;cesarean section decreased significantly from 58.52%in 2015.3.1?2017.2.28 to 46.42%in 2017.4.1 and neonatal asphyxia from 0.39%in 2015.3.1?2017.2.28 to 2017.4.One-0.27%of 2019.3.31;the perineal ? degree laceration rate decreased from 0.000377%of 2015.3.1?2017.2.28 to 0.000346%of 2017.4.1?2019.3.31.ConclusionVaginal midwifery,such as fetal head attraction and forceps,is a practical obstetric midwifery technique in this study,however,the technique is not pay attention by many hospitals,resulting in many junior doctors could not do this.In 2017,our hospital conducted the simulation training of all levels of gynecologists and midwives,through the application of labor forceps,fetal aspiration indications,contraindications,and choose different midwifery according to different conditions,According to "demonstration operation-review-operation-reoperation-assessment" the whole process of the training was conducted.After simulated training,we summarizes and improves the way of midwifery technical training,improved the vaginal midwifery technology of the vast number of medical personnel,especially the basic level medical staff,reduce the rate of cesarean section,improve the quality of Obstetrics and optimize the outcome of mother and child.It has been proved that Koch's evaluation model can not only evaluate the training effect objectively and comprehensively,but also reveal the existing problems objectively.