Even when complications arise, few pregnancies and deliveries are life-threatening. But in very unusual instances, conditions such as amniotic fluid embolism, thyroid storm or myocardial infarction in pregnancy can quickly endanger both mother and child. Although these situations are still rare, their incidence is growing as women delay childbearing late into their reproductive years, increasing the risk of comorbidities.
“In obstetrics, 99 percent of the time we don’t expect to take care of something that becomes a critical care case acutely,” says Andrew Satin, director of the Johns Hopkins Department of Gynecology and Obstetrics. “You can’t train for these things while they’re happening. You just have to know how to do it.”
That’s why Satin and Hopkins colleagues from specialties including obstetrics and gynecology, maternal-fetal medicine, neonatal intensive care, anesthesiology, nursing and others have created video simulation trainings on more than a dozen rare but critical conditions that can arise during pregnancy and delivery.
To develop the videos, partially funded by a grant from the Society for Maternal-Fetal Medicine, Satin and his colleagues worked with experts from Johns Hopkins and elsewhere to decide key teaching points and write scripts for each simulation. All videos were taped at Johns Hopkins’ state-of-the-art simulation center, with help on production values from Hopkins maternal-fetal medicine fellow Clark Johnson, who was a drama major as an undergraduate.
The fact that the Society for Maternal-Fetal Medicine chose Johns Hopkins to create the videos is a reflection of its long history as a tertiary care center for these rare conditions as well as a leader in simulation training. “We do simulation training for all levels of education, from undergraduate medical education to graduate, postgraduate and continuing education,” Satin says.
Several years ago, he and his colleagues also developed simulation training for managing shoulder dystocia, a program now used by many hospitals across the country.
“These simulations,” says Satin, “are valuable tools in our efforts to reduce patient harm and ensure quality and safety.”
WHEN MINUTES MATTER
Available on Johns Hopkins’ Department of Gynecology and Obstetrics website and as part of an online obstetric critical care course through the Society for Maternal-Fetal Medicine, examples of the videos depict management of:
- Massive transfusion
- Placenta accreta
- Cardiac disease and hypertension
- Thromboembolic disease
- Thyroid storm
- Diabetic ketoacidosis
- ARDS/pulmonary edema
- Amniotic fluid embolism
- OB-specific ACLS and trauma care
- Invasive monitoring in pregnancy