An interactive education system for teaching patient care to a user is described. The system comprises a patient simulator; a virtual instrument for use with the patient simulator in performing patient care activities; means for sensing an interaction between the virtual instrument and the simulator, and means for providing feedback to the user regarding the interaction between the virtual instrument and the simulator. In one aspect, the system includes a maternal simulator, a fetal simulator, and a neonatal simulator.

Interactive education system for teaching patient care

PURPOSE AND SCOPE The purpose of these Guidelines is to review the published techniques of ultrasound in labor and their practical applications, to summarize the level of evidence regarding the use of ultrasound in labor and to provide guidance to practitioners on when ultrasound in labor is clinically indicated and how the sonographic findings may affect labor management We do not imply or suggest that ultrasound in labor is a necessary standard of care

ISUOG Practice Guidelines: intrapartum ultrasound.

Objective
To investigate the ability of intrapartum translabial sonography to diagnose fetal station in the second stage of labor.

Methods
Patients with uncomplicated pregnancies at term gestation with fetuses in vertex presentation in the second stage of labor underwent serial translabial sonography and digital examinations. In a sagittal section of the maternal pelvis, the direction of the head was noted and categorized as downward, horizontal or upward. By rotating the transducer in the transverse plane the cerebral midline echo was also visualized and the rotation of the head was noted. Clinical and ultrasound data were compared using Somer's d-test.

Results
Sixty patients underwent a total of 168 clinical and sonographic examinations. When on the sonogram the fetal head was directed downward, the station assessed clinically was most frequently ≤ + 1 cm from the ischial spines (44/57 (77.2%) cases); when the direction was horizontal, the station was most frequently ≤ + 2 cm (53/59 (89.8%) cases); when the fetal head was directed upward, the station was usually ≥ + 3 cm (46/52 (88.5%) cases). Failure to visualize the cerebral midline or a rotation ≥ 45° were associated with a station of + 2 cm or less in 98/103 (95.1%) examinations. Conversely, a rotation of < 45° was associated with a station of + 3 cm or more in 45/65 (69.2%) examinations. All comparisons between clinical and sonographic findings demonstrated a statistically significant relationship (P < 0.0001). The probability of a station + 3 cm or more was particularly high when an upward direction of the head was seen in combination with a rotation of < 45° (40/42 (95.2%) examinations). The interobserver variability (Cohen's kappa 0.795 and 0.727 for station and rotation, respectively; P < 0.001) and intraobserver variability (0.845 for both station and rotation, P < 0.001) suggested good reproducibility of the method.

Conclusions
Translabial sonography allows a diagnosis of fetal station with an accuracy comparable to that of digital examination and may provide useful information for diagnosing obstructed labor in the second stage as well as assisting in the choice of instrumental delivery. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd.

Diagnosis of station and rotation of the fetal head in the second stage of labor with intrapartum translabial ultrasound

Objectives
To assess whether ultrasound experience or fetal head station affects the reliability of measurement of fetal head descent using the angle of progression on intrapartum ultrasound images obtained by a single experienced operator, and to determine reliability of measurements when images were acquired by different operators with variable ultrasound experience.

Methods
One experienced obstetrician performed 44 transperineal ultrasound examinations of women at term and in prolonged second stage of labor with the fetus in the occipitoanterior position. Three midwives without ultrasound experience, three obstetricians with 10 years' experience measured fetal head descent based on the angle of progression in the images obtained. The angle of progression was measured by two obstetricians in independent ultrasound examinations of 24 laboring women at term with the fetus in the cephalic position to allow assessment of the reliability of image acquisition. Intraclass correlation coefficients (ICCs) with 95% confidence interval (CI) were used to evaluate interobserver reliability and Bland–Altman analysis was used to assess interobserver agreement.

Results
In total, 444 measurements were performed and compared. Interobserver reliability with respect to offline image analysis was substantial (overall ICC, 0.72; 95% CI, 0.63–0.81). ICCs were 0.82 (95% CI, 0.70–0.89), 0.81 (95% CI, 0.71–0.88) and 0.61 (95% CI, 0.43–074) for observers with > 10 years', 10 years' and < 5 years' ultrasound experience (bias, −1.09°; 95% limits of agreement, −8.76 to 6.58). The reliability of measurement of the angle of progression following separate image acquisition by two experienced operators was similar to the reliability of offline image analysis (ICC, 0.86; 95% CI, 0.70–0.93).

Conclusions
Measurement of the angle of progression on transperineal ultrasound imaging is reliable regardless of fetal head station or the clinician's level of ultrasound experience. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.

https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1002/uog.7521

Measurement of fetal head descent using the ‘angle of progression’ on transperineal ultrasound imaging is reliable regardless of fetal head station or ultrasound expertise

Objective

Several ultrasound parameters, including intrapartum transperineal ultrasound (ITU) head station, angle of progression (AOP), head–perineum distance (HPD) and head-symphysis distance (HSD), have been suggested to assess fetal head station during labor. The aim of this study was to analyze the relationship between these ultrasound parameters and to compare them with digital palpation.



Methods

We analyzed 106 stored volume dataset pairs that had been acquired at Stavanger University Hospital, Norway, from nulliparous women at term with prolonged first stage of labor. The volumes were acquired using a three-dimensional transducer applied between the labia majora in a mid-sagittal plane and perineally in a transverse plane. Digitally palpated head station and cervical dilatation were also noted. The results were compared using regression and correlation coefficients.



Results

There were good correlations between ITU head station and HPD (r = 0.71), between ITU head station and HSD (r = 0.74) and between HSD and HPD (r = 0.75). Palpated head station showed only moderate correlation with ITU head station (r = 0.52). Cervical dilatation showed a weak correlation with ITU head station (r = 0.30).



Conclusion

The ultrasound parameters showed a high degree of correlation with each other, but only moderate correlation to vaginally palpated fetal head station. Copyright © 2013 ISUOG. Published by John Wiley & Sons, Ltd.

Comparison between ultrasound parameters and clinical examination to assess fetal head station in labor

Birth simulator: Reliability of transvaginal assessment of fetal head station as defined by the American College of Obstetricians and Gynecologists classification

The simulator has a foetal system (2) including a foetal head and simulating the behavior of at least a part of a foetus The foetal head is connected to an actuator (8) arranged to exert a force on the head A maternal system (3) simulates the behavior of a part of maternal body interacting with the foetus An obstetric instrument eg forceps, comprises of pressure transducers (30)

Childbirth simulator for e.g. training doctor, has foetal system with foetal head to simulate behavior of foetus part, maternal system to simulate maternal body part behavior, and obstetric instrument e.g. forceps, with pressure transducers

The present invention relates to a sensor (10) for interface pressure between two bodies, comprising at least two detection zones (11) communicating with each other, each detection zone being formed inside an envelope ( 12) inflatable for interposed between said bodies and having two opposite regions whose spacing depends on the interface pressure between said bodies, each detection zone comprising a detector (15a, 15b) arranged to deliver information related to the distance between the opposite regions (12a, 12b).

Sensor device and method for measuring the interface pressure between two bodies

The invention relates to a thermometer (T) for non-invasive measurement of a body temperature (Tc) of a subject, the thermometer being intended to be applied on the skin (P) of said subject and comprising a support plate (18) of which an outer surface is intended to be in contact with the skin (P) for performing the temperature measurement, the thermometer comprising two temperature measuring elements, - the first (16), in contact with a central zone (C) of the support plate (18) so as to measure a temperature (TP) to the skin (P) of the subject, the second (19) eccentrically and in thermal contact with the central region (C) of the measuring plate (18), - an insulator (10) having at least one peripheral zone of insulation at the support plate (18), and further defining a thermal channel (100) wherein are arranged the measuring elements (16 , 19)

Thermometer body improves

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Birth simulator: Reliability of transvaginal assessment of fetal head station as defined by the American College of Obstetricians and Gynecologists classification

Childbirth simulator for e.g. training doctor, has foetal system with foetal head to simulate behavior of foetus part, maternal system to simulate maternal body part behavior, and obstetric instrument e.g. forceps, with pressure transducers

Sensor device and method for measuring the interface pressure between two bodies

Thermometer body improves