ORIGINAL ARTICLE   

Minerva Obstetrics and Gynecology 2025 Jan 16

DOI: 10.23736/S2724-606X.24.05614-8

Copyright © 2024 EDIZIONI MINERVA MEDICA

language: English

Vaginal delivery of the second twin: simulation to improve trainee knowledge and comfort

Claudio CELENTANO ^{1, 2}, Daniela A. IACCARINO ^{1, 2, 3} ✉, Barbara MATARRELLI ³, Maurizio ROSATI ^{1, 2}, Federico PREFUMO ⁴

¹ Department of Obstetrics and Gynecology, Santo Spirito Hospital, G. d’Annunzio University of Chieti-Pescara, Pescara, Italy; ² Emergency Advanced Simulation Center, Santo Spirito Hospital, Pescara, Italy; ³ Department of Obstetrics and Gynecology, SS. Annunziata Hospital, G. d’Annunzio University of Chieti-Pescara, Chieti, Italy; ⁴ Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy

BACKGROUND: Vaginal delivery in twins is feasible but challenging. Successful vaginal delivery of a non-vertex second twin depends on knowledge of specific obstetrical maneuvers. Skill acquisition at the patient’s bedside is difficult, making simulation training an integral part of obstetrics and gynecology residency programs.
METHODS: This prospective, randomized, controlled, single-center study involved obstetrics and gynecology residents. Group A attended a frontal lecture followed by practical simulation; Group B received digital home learning. One month later, both groups underwent a simulation test to identify fetal small parts using a birth simulator with a fetus model placed in a simulated amniotic cavity. Training was conducted with an actor facilitator and supervised by six specialists, focusing on obtaining information, using external and internal hands. A 25-question Likert scale questionnaire was administered via Google Forms. Metrics evaluated included time to reach foot/feet, number of attempts, and answers on Kirkpatrick levels 1-4.
RESULTS: Twenty-four participants were recruited and randomized into two groups, with five lost to follow-up at the time of the simulation test. Group A required less time for internal podalic version and breech extraction of the second twin (P=0.02) and fewer attempts to reach the foot/feet of the second twin (P=0.01). Supervisor evaluations of “asking information” and “internal hand use” were better in Group A.
CONCLUSIONS: Simulation training for the vaginal delivery of a non-vertex second twin is feasible and has a favorable impact on resident performance.

KEY WORDS: Obstetric delivery; Medical education; Preceptorship