Simulation Training for Forceps-Assisted Vaginal Delivery and Rates of Maternal Perineal Trauma

Obstet Gynecol. 2016 Sep;128(3):429-435. doi: 10.1097/AOG.0000000000001533.


Objective: To evaluate the association of a forceps simulation training curriculum for obstetrics residents on rates of severe perineal lacerations after forceps deliveries.

Methods: This was a retrospective cohort study. We created a novel simulation curriculum for forceps-assisted vaginal delivery based on the best practices of local experts, and trained all residents beginning in 2013. We then retrospectively reviewed all forceps deliveries performed in the 2.5 years after initiation of the training and the 7.5 years before the training program. We identified patients who experienced a severe perineal laceration (third- or fourth-degree) and examined the relationship of resident training status and perineal laceration. Known risk factors for lacerations were identified and a multilevel multivariable model was created including these factors as well as resident training.

Results: During the study period, we identified 6,058 forceps-assisted vaginal deliveries. We examined temporal trends in rates of forceps of severe perineal laceration. We identified a decrease in severe lacerations between 2005 and 2008, ending 5 years before the initiation of the training curriculum. These years were censored from the data, yielding a baseline observational period of 4,279 deliveries with no significant trend in laceration rate. Univariate analysis reveals a 22% reduction in severe perineal laceration (odds ratio [OR] 0.78; P=.005) among women delivered by residents who had completed forceps simulation training compared with women delivered by residents who had not. After adjusting for known maternal and delivery risk factors for perineal laceration, the magnitude of the reduction increased to 26% in the full data set model (OR 0.74; P=.002).

Conclusion: A forceps simulation curriculum for obstetrics residents was associated with a significant reduction in severe perineal lacerations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Educational Status
  • Extraction, Obstetrical* / adverse effects
  • Extraction, Obstetrical* / education
  • Extraction, Obstetrical* / instrumentation
  • Extraction, Obstetrical* / methods
  • Female
  • Humans
  • Internship and Residency / methods*
  • Lacerations* / diagnosis
  • Lacerations* / etiology
  • Lacerations* / prevention & control
  • Obstetric Labor Complications* / diagnosis
  • Obstetric Labor Complications* / etiology
  • Obstetric Labor Complications* / prevention & control
  • Obstetrical Forceps / adverse effects
  • Perineum / injuries*
  • Pregnancy
  • Program Evaluation
  • Retrospective Studies
  • Risk Factors
  • Simulation Training / methods*
  • Trauma Severity Indices