Resident Operative Vaginal Delivery Volume after Educational Curriculum Implementation

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.

Keywords

forceps - operative vaginal delivery - resident education - vacuum

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

Article published online:
26 May 2020

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