Am J Perinatol 2020; 37(13): 1296-1300
DOI: 10.1055/s-0040-1710543
SMFM Fellowship Series Article

Resident Operative Vaginal Delivery Volume after Educational Curriculum Implementation

David A. Becker
1  Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama
,
Christina T. Blanchard
1  Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama
,
Jeff M. Szychowski
1  Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama
,
Sharee L. Rogers
1  Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama
,
Cynthia G. Brumfield
1  Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama
,
Akila Subramaniam
1  Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama
› Author Affiliations
Funding None.

Abstract

Objective The percentage of operative vaginal deliveries (OVDs) in the United States has sharply declined. In May 2016, our institution's obstetrics and gynecology (OB/GYN) residency program implemented a twice-yearly OVD curriculum consisting of didactics and simulation. We sought to evaluate the impact of this curriculum.

Study Design We performed a retrospective cohort study of all deliveries at our institution from July 2011 to May 2018. Deliveries were evaluated quarterly for the pre- (July 2011–April 2016) and postcurriculum (July 2016–May 2018) periods. Forceps-assisted vaginal delivery (FAVD), vacuum-assisted vaginal delivery (VAVD), and total OVD percentages, and the ratio of forceps to vacuums were calculated. Pre- and postcurriculum percentages were compared using Wilcoxon's rank-sum test. Cubic regression curves were fit to quarterly percentages to illustrate trends over time.

Results The quarterly OVD percentage was unchanged following curriculum implementation (mean 3.2% [Q1–Q3: 2.6–3.5%] pre- vs. 3.1% [2.5–3.8%] post-, p > 0.99). The FAVD percentage was increased (1.2% [0.8–1.5%] vs. 2.0% [1.4–2.6%], p = 0.027) and the VAVD percentage was decreased (2.0% [1.6–2.2%] vs. 1.2% [0.9–1.3%], p < 0.001). This was accompanied by an increase in the ratio of FAVD to VAVD (0.6 [0.4–0.8] vs. 1.7 [1.3–2.2], p < 0.001). FAVD percentage (3.1%) was higher in the last quarter than any other quarter in the 7-year study period, and total OVD percentage (3.9%) was higher in 2018 than any other calendar year.

Conclusion The implementation of an OVD curriculum in our OB/GYN residency program resulted in an increase in the percentage of FAVD and the ratio of FAVD to VAVD.

Key Points

  • OVD utilization in the United States continues to decline.

  • We demonstrate real-world impact of an OVD curriculum.

  • OVD curriculum implementation increases usage of FAVD.

Note

All individuals who contributed to this work have met standard criteria for authorship. This work was presented as a poster presentation for the Society of Maternal-Fetal Medicine's 39th Annual Pregnancy Meeting in February 11–16, 2019 in Las Vegas, NV.




Publication History

Received: 10 January 2020

Accepted: 04 April 2020

Publication Date:
26 May 2020 (online)

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