Simulation Device for Uterine Atony in the Identification of Postpartum Hemorrhage: Overview of Prototyping, Testing, and Design Instructions.

INTRODUCTION

Women who experience postpartum hemorrhage (PPH) after giving birth rapidly lose blood, which may lead to shock or death without immediate intervention. PPH most often results from uterine atony, when the uterus fails to contract after delivery. Worldwide, PPH causes 10 deaths hourly, with most deaths occurring in low-income settings. In these settings, medical staff may lack the training to identify the complication. Although uterine atony training models exist, many cost >$5000.

METHODS

To address the need for affordable training models, the Hemorrhage Education Reimagined (HER) model was created to train medical professionals to identify an atonic uterus through a bimanual examination after vaginal delivery. Twenty-five obstetrics and gynecology residents and attendings from an academic hospital evaluated the stages of atony of the HER model. Participants were asked to physically evaluate the model and give feedback on improvements to the model.

RESULTS

More than 80% of medical professionals were able to correctly discern an atonic uterus from a healthy uterus, but many had difficulty differentiating the moderately atonic uterus model from the severely atonic uterus model. The model met established design criteria, including low cost (<$100) and durability (more than 100 uses).

CONCLUSIONS

The HER model is a low-cost uterine atony model. Its implementation empowers medical professionals to practice identifying uterine atony, with potential implications to improve the diagnosis of PPH. Current limitations include use of high-cost fabrication methods, such as laser cutting and 3D printing. Lower-cost options could include constructing the abdomen using cardboard or wood and hand molding the vaginal canal using clay.