Are Junior Residents Accurate at Predicting Fetal Weight? An Analysis of Junior Residents' Performance of Estimated Fetal Weight Using Ultrasound and Leopold's Maneuver.

Background: Performing accurate estimated fetal weights (EFWs) is a critical skill developed in obstetrics residency training. Resident physicians are often the first to perform EFWs on obstetric patients when they enter care. Evaluating residents' accuracy in performing EFWs is crucial for assessing their achievement in residency training milestones and providing patient care. Methods: As part of an educational initiative program between 2014 and 2020, postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2) residents performed EFW measurements on 10 term (>37w0d) patients using ultrasound and Leopold's maneuver and 10 preterm (>24w0d and <37w0d) patients using ultrasound. Clinical characteristics, mode of delivery, and actual birthweights (BWs) were recorded for each patient. The accuracy of these estimates was evaluated using mixed-effect regression models. Results: Thirty-three residents, 1127 deliveries, and 1790 EFW measurements were evaluated. Overall, the percentage of residents with estimations within 10% of actual BW went up in PGY2 for Leopold's and ultrasound term births, but not for preterm ultrasound births. Maternal body mass index and actual BW were associated with absolute percentage estimation error. After adjusting for these variables, there was a statistically significant decrease in error between PGY1 and PGY2 for Leopold's method in term births; ultrasound (term and preterm) showed more modest reductions in error during PGY2. Discussion: Resident physicians have accurate estimates of EFWs early in their training, beginning in their first year of residency by both Leopold's maneuver and ultrasound. Furthermore, PGY2 residents performed better than PGY1 residents for Leopold's method.

Accuracy of Estimated Fetal Weight by Ultrasound Versus Leopold Maneuver.

ABSTRACT: Estimated fetal weight (EFW) is frequently used for clinical decision-making in obstetrics. The goals of this study were to determine the accuracy of EFW assessments by Leopold and ultrasound and to investigate any associations with maternal characteristics. Postgraduate years 1 and 2 obstetrics and gynecology resident physicians from Harbor-UCLA Medical Center from 2014 to 2020 performed EFW assessments on 10 preterm (<37 weeks' gestational age) fetuses by ultrasound biometry and 10 full-term (≥37 weeks' gestational age) fetuses by ultrasound biometry and Leopold maneuver. Assessments were included if the patients delivered within 2 weeks of the assessments. One thousand six hundred ninety-seven EFW assessments on 1183 patients performed by 33 residents were analyzed; 72.6% of sonographic full-term EFWs, 69% of Leopold full-term EFWs, and 61.5% of sonographic preterm EFWs were within 10% of the neonatal birth weight (BW). The lowest estimation error in our study occurred when actual BW was 3600 to 3700 g. After adjusting for BW, residents were found to have lower accuracy when the mother had a higher body mass index (BMI) for full-term estimation methods (Leopold and ultrasound, ß = 0.13 and 0.12, P = 0.001 and 0.002, respectively). Maternal BMI was not related to estimation error for preterm fetuses ( ß = 0.01, P = 0.75). Clinical and sonographic EFW assessments performed by obstetrics and gynecology junior residents are within 10% of neonatal BW much of the time. In our cohort, they tended to overestimate EFWs of lower-BW infants and underestimate EFWs of higher-BW infants. Accuracy of full-term EFW assessments seems to decrease with increasing maternal BMI.

Low-Cost, Durable Sheepskin Uterine Model for Obstetric Hemorrhage Emergency Simulation.

OBJECTIVE: Postpartum hemorrhage is a common obstetrical emergency. Because the majority of cases respond to conservative medical therapies, trainees have limited clinical experience with hemostatic sutures or placement of a Bakri intrauterine balloon for refractory postpartum hemorrhage. Simulations provide an invaluable adjunct to resident education to learn and practice these hemostatic techniques. We aimed to create a low-cost, reproducible simulation model to prepare residents for uterine atony interventions such as B-Lynch, Bakri balloon placement, and uterine artery ligation. STUDY DESIGN: Using low-cost supplies, a reusable, life-sized recent postpartum uterus was constructed from pieces of sheepskin and sewn together with various expired suture. The sheepskin material allowed for repeated, secure placement of B-Lynch and O'Leary sutures and Bakri balloons, as well as offering the required compressibility to simulate a boggy uterus. Finally, sections of a red robin catheter were incorporated along the lateral lower borders of the model to simulate blood vessels for practicing uterine artery ligations. RESULTS: The model was used about 50 times over the span of 3 years to practice uterine hemostatic suturing. Residents found this model lifelike, accurate in size, and multifunctional for practicing these various techniques. The sheepskin material proved to be very resistant to repeated suturing, and also provided strong suture pull through strength. The durability of the sheepskin material demonstrates that this model can be used for repeated simulations or individual practice. CONCLUSION: The sheepskin uterus model provides trainees a realistic, low-cost, reproducible, simulation of a hypotonic uterus and allows for multiple modalities for managing postpartum hemorrhage. KEY POINTS: · We provide instructions for the creation of a sheepskin model for obstetric hemorrhage simulation.. · We demonstrate use of the sheepskin model in various obstetric hemorrhage management techniques.. · We demonstrate that the model is durable and lifelike based off of resident feedback..

Predictive Ability of Ultrasound on Neonatal Diagnoses and Consequences on Prenatal Care Utilization.

ABSTRACT: Fetal anomalies suspected on fetal ultrasound may cause significant stress for patients. Some findings resolve or have minimal clinical significance for the neonate. Our purpose is to evaluate fetal ultrasound accuracy and false-positive results and determine the clinical impact on maternal counseling. A retrospective review was performed on electronic medical records for women receiving prenatal care at Harbor-UCLA Medical Center who had abnormal findings on fetal ultrasounds between January 2015 and December 2018. Corresponding neonatal medical records were reviewed for the suspected condition(s). χ2 and Fisher exact tests were conducted to assess associations between fetal ultrasounds and neonatal outcomes. Two hundred eight mothers and 237 babies (including all 29 sets of twins) were included in the final analysis. Fetal ultrasounds were significantly associated with neonatal findings for the following conditions (sensitivity, specificity): anatomical disorder of extremities (0.72, 0.97), anatomical disorder of the face/skull/brain (0.67, 0.91), congenital anomaly of gastrointestinal tract (0.75, 0.98), congenital heart disease (0.75, 0.91), genetic disorder (0.72, 1.00), growth restriction (1.00, 0.85), kidney disorder (0.55, 0.98), and large for gestational age (0.80, 0.98). The highest false-positive rates occurred in congenital heart disease (65.4%), anatomical disorder of the face/skull/brain (64.3%), and growth restriction (54%). Fetal ultrasound highly correlates with neonatal findings for many congenital conditions. However, it can also be associated with a high false-positive rate for certain diagnoses; maternal counseling should include the limitations of ultrasound, including the potential for false-positive results.