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    DESPERATE DEBRA® - Impacted Fetal Head Simulator

    DESPERATE DEBRA® - Impacted Fetal Head Simulator - AR58
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    Adam Rouilly DESPERATE DEBRA® - Impacted Fetal Head Simulator

    Developed in collaboration with Dr Graham Tydeman, Consultant in Obstetrics and Gynaecology - NHS Fife, Professor Andy Shennan - Professor of Obstetrics, and Dr Annette Briley – Consultant Midwife, Clinical Trial Manager, Maternal and Fetal Research Unit, Guy’s and St Thomas’ Hospital, the Desperate Debra® simulator has been designed to facilitate the training and implementation of correct clinical procedures when confronted with impaction of the fetal head - a serious and potentially life threatening event.

    Obstetrics has taken the lead in reducing the number of perinatal and neonatal complications by developing emergency drills for major events such as shoulder dystocia and breech delivery using simulators. Until now, however, no simulator has previously been available for training in dealing with an impacted fetal head.

    Features in the Royal College of Obstetricians and Gynaecologists Operative Birth Simulation Training Course (ROBuST)

    Improving Training, Reducing Morbidity:
    • The Desperate Debra® simulator will allow for the development of emergency procedures, increase awareness and refine practices for current professionals as well as introducing the issue and ensuring confidence amongst trainees.

    70% Experience Rate:
    • 70% of surgeons in a survey group have had personal experience of difficulty in delivering an impacted fetal head at caesarean section.
    • 80% of those in the survey group had encountered serious maternal or fetal/ neonatal morbidities associated with difficulties in delivery of an impacted head.

    20,000 Birth Per Year Potential:
    • Many obstetricians first encounter impaction of the fetal head while in training, often at night without immediate access to senior help.
    • There are currently no figures for the exact incidence rate, but with around 200,000 caesarean sections in the UK each year with about 10% at full dilation, there is a potential for it to affect around 20,000 births per year.

    Increasing Incidences:
    • NICE states that women diagnosed with failure to progress in the first stage of labour should receive intravenous syntocinon prior to a decision to deliver by caesarean section.
    • This means that increasingly, women who fail to deliver vaginally are undergoing caesarean section in the late first and second stage of labour, when difficulty in delivering the impacted fetal head is most commonly reported.
    • Average maternal Body Mass Index (BMI) is also increasing. Pregnant women with high BMIs are more likely to have labour induced or augmented, an increased rate of caesarean section in the late first and second stage of labour and the intrapartum complications with impaction of the fetal head.

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