BACKGROUND:Obstetric emergency simulation training is an evidence-based intervention for the reduction of perinatal and maternal morbidity. In Western Australia, obstetric emergency training has been run using the In Time course since 2006. AIMS:The study aimed to determine if the provision of In Time train the trainer courses to outer metro, rural and remote units in Western Australia had led to sustained ongoing training in those units. Ten years following the introduction of the course, we performed a survey to examine which units are continuing to run In Time, what are the perceived benefits in units still utilising In Time, and what were the barriers to training in units that had discontinued. MATERIALS AND METHODS:A link to an online survey was sent to the units where In Time training had occurred. Telephone enquiries were additionally used to ensure a good response rate. RESULTS:The survey response rate was 100%. Six of the 11 units where training had been provided continue to run In Time. Units where training had discontinued had done so in order to take up alternatives, or as a result of trainers leaving. Of the units who had discontinued training, one wished to recommence In Time. CONCLUSIONS:Local in situ training in obstetric emergencies as exemplified by the In Time course remains a popular and valued training intervention across Western Australia. This training may be of particular benefit to small and remote units, but these are the areas in which training is hardest to sustain.

two approved regimens: double-dose of 500 IU at 28 and 34 weeks’ GA; and single-dose of 1500 IU at 28-weeks. Aim: To assess compliance and maintenance of circulating anti-D levels at delivery comparing singleand double-dose regimens of prophylaxis. A RCT (n = 280) compared a single 1500 IU dose of anti-D at 28-week to the current Australian regimen (28-and-34week 625 IU). Delivery antibody screening assessed circulating anti-D. Analyses were performed on intention to treat (ITT), and treatment received (TR). Statistical tests evaluated differences in compliance, detectability of residual anti-D, and maternal and neonatal outcomes. Multi variate logistic regression assessed factors contributing to undetectable anti-D at delivery. Demographic, obstetric and neonatal outcomes were similar between groups. No women sensitised during the study. Based on analyses by ITT and TR, the single-dose group had a higher proportion of undetectable anti-D at delivery (ITT OR 5.0; 45.2% vs. 14.2%, p < 0.001). Compliance was improved in the singledose group (77.1% vs. 60.7%, p < 0.001). Time elapsed since last dose, and third -trimester weight were significant predictors for undetectable anti-D at delivery. Multivariate regression indicated anti-D regimen group was not a significant predictor for undetectable anti-D at delivery. Based on individualized calculations of anti-D half-life, if Australia were to adopt a single dose regimen, there would be an estimated additional 15,641 women without adequate cover in the third-trimester.

Ian Callander, Jacqueline Stack Liverpool Hospital Background: The “Golden Opportunity” clinical practice improvement (CPI) project was started at Liverpool hospital in 2014 and participates in the NICUS ePREM72 CPI, which focuses on management of Extremely Low Gestational Age Neonates (ELGAN) within the first 72 hours of life. Method: Using translational research and principles of CPI we hold monthly meetings to develop and review a consistent approach to team management of ELGAN. The protocol continues to evolve as each case is individually reviewed and specifies the use of equipment and the role of 2 nurses and 2 doctors with the aim of maximising expertise and efficiency whilst minimising intervention to the baby. Results: During the first 72 hours for babies < 26 weeks 80% of babies are now managed only on CPAP compared to 50% previously; 85% of babies have no umbilical catheters compared to 35% previously; 95% of babies are not given inotropes compared with 80% previously. There is also a trend toward lower rates of death, major IVH, and NEC with no worsening of any other outcomes. Conclusions: Liverpool NICU has been able to dramatically reduce the interventions given to ELGAN without any detriment and indeed have apparently improved short-term stability and outcomes. Although there has been a trend across NSW/ACT toward reduction in interventions, the practice at Liverpool is dramatically different from the other hospitals on benchmarking reports. This presentation outlines the process of the Liverpool “Golden Opportunity” CPI project.

Background: Operative vaginal delivery is a common obstetric intervention, with the potential to cause harm to mother and baby. Training in operative delivery traditionally comprised junior trainees learning the skills under supervision, then practicing and refining them independently. Recently this model has come under scrutiny, with the advent of simulation-based training suggesting a method by which the skills of safe delivery may be taught without risk. Multiple training courses exist, but few have been subjected to evaluation. Aims: The primary aim was to investigate if a simulation-based training workshop, where the development of a successful technique for vacuum delivery occurs using a collaborative, problem-solving approach, improves the rate of correct vacuum cup placement. The secondary aim was to determine if the workshop leads to improvement in theoretical knowledge of vacuum delivery. Methods: Participants on three workshops were assessed for their performance in vacuum delivery prior to and following a multimodal training program. Participants included general practitioner obstetricians, obstetric trainees and resident medical officers. Evaluation occurred using a standardised Likert-scaled rating sheet and utilising a diagrammatic representation of cup placement. Results: The participants demonstrated significant improvement (median post-pre score 1, p in the accuracy of cup placement, in a variety of practical core skills and in theoretical knowledge of vacuum delivery. Discussion: Participation in a simulation-based vacuum delivery workshop improves the performance of obstetric trainees and GP obstetricians. Further work is required to evaluate the performance of such training modalities on clinically relevant outcomes.

Cord prolapse is an uncommon obstetric emergency, with potentially fatal consequences for the baby if prompt action is not taken. Simulation training provides a means by which uncommon emergencies can be practised, with the aim of improving teamwork and clinical outcomes.