Nostra prima esperienza di team training con l'aiuto di noelle® durante una giornata intensiva di simulazione del trattamento dell'emorragia post partum

Obstetric emergencies could be managed efficiently if systematic teaching and specific training were available for obstetric teams. Obstetric high risk critical conditions are shoulder dystocia, emergent cae-sarean section, eclampsia and postpartum haemorrhage (PPH). The latter is, actually, an ideal scenario for multidisciplinary training aimed at avoiding common medical errors and reducing maternal preventable mortality. We describe our experience in a multidisciplinary, theoretical/practical course realized using the high-fidelity full body interactive simulator Noelle ^® (Gau-mard, USA). After brief didactical lectures about medical and surgical treatment of postpartum haemorrhage (uterotonics, compressive and haemostatic sutures, selective arterial embolization, peripartum hysterectomy), the teaching moved to simulation rooms were two scenarios of postpartum uterine atony had been arranged (the first after vaginal birth, the second after caesarean section in twin pregnancy). The simulation involved two different teams, each composed of 3 learners (2 midwives and 1 obstetrician) supervised by one tutor. Informatics' assistance by a Gaumard engineer allowed continuous visualization of maternal vital parameters. Moreover, the engineer wireless directed the bleeding rate, modulating it according to the clinical phase of the simulation scenario. Practical teaching was followed by evaluation of the simulation recorded. This phase, called debriefing, is of great importance: observing the videos allowed the trainees to identify any mistake in clinical management, integrating theoretical knowledge with practical assessment. Eventually, complex practical skills, such as selective arterial ligation, compressive sutures and peripartum hysterectomy, were performed by a supervisor and by the learners on a uterine prototype. We administered a questionnaire about postpartum haemorrhage management before and after the course to assess the benefits from theoretical/practical simulation-based teaching. The results of the test were significantly better at the end of the session.