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OBJECTIVE: Since the 1990’s, simulation has been used to maintain task-oriented and behavioral skills in obstetrics and gynecology. Data on its effectiveness is still limited. The purpose of this study is to describe our experience in implementing simulation exercises at a large, private hospital. STUDY DESIGN: After reviewing the malpractice claims and maternal mortality impact of shoulder dystocia and postpartum hemorrhage, and the potential for a positive impact on patient safety through simulation training, shoulder dystocia and postpartum hemorrhage were selected as the initial focus of a new simulation training program for attending obstetrical physicians at a large, private, urban hospital. Upon obtaining approval from the institution, the Simulation Working Group developed an obstetrical simulation program emphasizing the management of shoulder dystocia and postpartum hemorrhage. Physicians who participate in deliveries at the institution were required to review a web-based educational program prior to the simulation exercise. Pre and post test questions were developed to assess the effectiveness of the information provided. The data was analyzed using Chi-Square testing with a p-value of

Study Objective To assess adverse events associated with radiofrequency endometrial ablation in treatment of heavy menstrual bleeding in patients with a history of low transverse cesarean delivery (C-section group) and patients who delivered vaginally (vaginal delivery group). Design Retrospective cohort study (Canadian Task Force classification II-2). Setting Community-based gynecology practice in the United States. Patients The study included 194 patients (100 in the C-section group and 94 in the vaginal delivery group), aged 21 to 55 years, with a history of heavy menstrual bleeding. Interventions NovaSure endometrial ablation procedures were performed from April 2004 through December 2010. Measurements and Main Results Demographic characteristics, gynecologic and pregnancy history, and procedure setting were compared between groups. Intraoperative and postoperative adverse events that occurred within 72 hours of the procedure were summarized. The C-section and vaginal delivery groups were similar for demographic characteristics with the exception of age (mean [SD], 40.6 [5.0] years vs 42.5 [5.3] years, respectively; p = .01). Parity was significantly higher in the C-section group compared with the vaginal delivery group (2.4 [0.9] vs 2.1 [0.7]; p = .006). Adverse events commonly associated with endometrial ablation occurred in 3 patients in the C-section group and 5 patients in the vaginal delivery group (p = .68). In addition, 1 patient failed the pre-ablation cavity integrity assessment; therefore, ablation was not performed. All events resolved without sequelae. No uterine perforation or bowel or bladder injury occurred in any patient. Conclusion Radiofrequency endometrial ablation performed in a community practice was well tolerated in patients with a history of low transverse cesarean delivery.