Vaginal delivery of the second twin: simulation to improve trainee knowledge and comfort

BACKGROUND: Vaginal delivery in twins is feasible but challenging. Successful vaginal delivery of a non-vertex sec- ond twin depends on knowledge of specific obstetrical maneuvers. Skill acquisition at the patient's bedside is difficult, making simulation training an integral part of obstetrics , gynecology residency programs. METHODS: This prospective, randomized, controlled, single-center study involved obstetrics and gynecology residents. Group A attended a frontal lecture followed by practical simulation; Group B received digital home learning. One month later, both groups underwent a simulation test to identify fetal small parts using a birth simulator with a fetus model placed in a simulated amniotic cavity. Training was conducted with an actor facilitator and supervised by six special- ists, focusing on obtaining information, using external and internal hands. A 25-question Likert scale questionnaire was administered via Google Forms. Metrics evaluated included time to reach foot/feet, number of attempts , answers on Kirkpatrick levels 1-4. RESULTS: Twenty-four participants were recruited and randomized into two groups, with five lost to follow-up at the time of the simulation test. Group A required less time for internal podalic version and breech extraction of the second twin (P=0.02) and fewer attempts to reach the foot/feet of the second twin (P=0.01). Supervisor evaluations of "asking information" and "internal hand use" were better in Group A. CONCLUSIONS: Simulation training for the vaginal delivery of a non-vertex second twin is feasible and has a favorable impact on resident performance.