Impact of timely obstetric simulation on vaginal breech delivery management


  • Georges J. Yared Department of Obstetrics and Gynecology, Lebanese American University, Beirut, Lebanon
  • Jihad M. Al Hasssan Department of Obstetrics and Gynecology, Rafik Hariri Hospital University Medical Center, Beirut, Lebanon
  • Charlotte A. El Hajjar Department of Obstetrics and Gynecology, Lebanese University, Beirut, Lebanon
  • Kariman S. Ghazal Department of Obstetrics and Gynecology, Rafik Hariri Hospital University Medical Center, Beirut, Lebanon



Assisted vaginal delivery, Breech presentation, Neonatal outcomes, Obstetrics, PROMPT, Simulation-based training


Background: The management of breech presentations represents a significant challenge in obstetrics, necessitating advanced skills for optimal clinical outcomes. Simulation-based training has emerged as a promising approach to enhance the proficiency of healthcare professionals in assisted vaginal breech deliveries, potentially improving neonatal outcomes.

Methods: This research study was conducted at Rafic Hariri University Hospital, Beirut, to evaluate the impact of simulation-based training on the management of breech presentations. Using Robson’s classification, a comparative analysis was performed on the outcomes of breech deliveries before and after the implementation of this training. The focus was primarily on assisted vaginal deliveries within the R6 (all nulliparous women with a single breech baby, cesarean section) and R7 (all multiparous women with a single breech baby, cesarean section) groups.

Results: Post-training, there was a notable increase in the rate of assisted vaginal deliveries in the R6 category, indicating the effectiveness of the simulation-based training. However, the rate of assisted vaginal deliveries within the R7 group showed no significant change. Additionally, the positive impact of the training demonstrated a time-sensitive decline, underscoring the necessity for ongoing practice and reinforcement of skills.

Conclusions: Simulation-based training offers substantial benefits in managing breech presentations, particularly evident in the increased rate of assisted vaginal deliveries among nulliparous women (R6). However, the absence of change in the multiparous women (R7) group and the time-sensitive reduction in training effectiveness highlight the critical need for continuous skill development and reinforcement.


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