WO2001080203A1

WO2001080203A1 - Obstetrics training aid

Info

Publication number: WO2001080203A1
Application number: PCT/GB2001/001560
Authority: WO
Inventors: Michael Markiewicz; Bindu Dasoju; Dimple Devadas
Original assignee: Cybermedix Limited
Priority date: 2000-04-14
Filing date: 2001-04-05
Publication date: 2001-10-25
Also published as: GB2363241A; GB0009335D0; GB0108607D0; AU4440401A

Abstract

An obstetrics training aid (10, 30) comprising a chamber (12, 32) having an entrance opening (15) to simulate a vagina; a plurality of apertured elements (20, 40) having differently sized apertures (22, 42) of bell-like form therein in simulation of a cervix and representing the cervix at different stages of dilation; and means within the chamber for positioning behind said vagina-simulating opening (15) a selected one of said cervix-simulating apertured elements (20, 40). The vagina-simulating opening (15) is bounded by flexible, resilient, material (16) to define that opening as an elongate slit (15). A plurality of different cervix-simulating apertured elements (20, 40) can be provided on a plurality of independent plates (20) or on a single carrier plate (40) rotatably mounted within the chamber in the manner of a turret. In either case the distance between the vagina-simulating opening (15) and the selected apertured element (20, 40) may be varied. It is envisaged that with such a training aid (10, 30), trainee medical personnel can, by simulation, gain experience of a variety of obstetric conditions and delivery stages in accord with the perceived size of the selected cervix-simulating apertures (22, 42) as felt by the trainee's fingers inserted from outside the chamber through the vagina-simulating opening (15).

Description

OBSTETRICS RAINING AID

DESCRIPTION

Technical Field

This invention relates to training aids, and particularly such aids for training medical personal in aspects of obstetrics. Optionally embodiments of the invention may additionally aid in training such personnel in aspects of gynaecology.

Medical personnel such as obstetricians, non-obstetrician doctors, midwives and students for these occupations, require training in the accurate determination of obstetric conditions, especially during childbirth by a female patient. In the past the primary, if not only, method available for acquiring the skill of such accurate determination has been experience gained from live physical examination of many women during the process of delivering a child. However such live physical examination by a trainee is a non-essential intervention that can be disturbing to the mother-to-be, and may be medically detrimental to the mother-to-be and/or to the baby being delivered.

Clearly it is desirable to provide a training aid whereby the above-mentioned and/or other disadvantages of obstetrics traimng can be overcome or at least minimised.

To this end, one aspect of the present invention provides an obstetrics training aid comprising a chamber having an entrance opening to simulate a vagina; a plurality of apertured elements having differently sized apertures therein in simulation of a cervix and representing the cervix at different stages of dilation; and means within the chamber for positioning behind said vagina-simulating opening a selected one of said cervix-simulating apertured elements.

It is envisaged that with such a training aid, trainee medical personnel can, by simulation, gain experience of a variety of obstetric conditions and delivery stages in accord with the perceived size of the selected cervix-simulating apertures as felt by the trainee's fingers inserted from outside the chamber through the vagina-simulating opening.

Preferably the vagina-simulating opening is bounded by flexible, preferably resilient, material to define that opening as an elongate slit.

In a first preferred embodiment of the invention, the plurality of different cervix- simulating apertured elements are provided on a plurality of independent plates of which any one (when selected) can be slid into the chamber through a slot in a wall of the chamber and until its cervix-simulating aperture is located behind the vagina- simulating opening.

In a second preferred embodiment of the invention, some or all of the plurality of different cervix-simulating apertured elements are provided on a single carrier plate rotatably mounted within the chamber in the manner of a turret such as to position selectively any one of its apertured elements behind the vagina-simulating opening.

With either said embodiment the distance between the vagina-simulating opening and the selected apertured element may be varied.

Advantageously each said cervix-simulating aperture is of bell-like form.

Advantageously the training aid further comprises a simulation of part of the body of a foetus or baby, this baby-body-part simulation being in use located within the chamber rearwardly of the selected cervix-simulating aperture element. Preferably the training aid comprises a plurality of different baby-body-part simulations, any one of which being selectable for location rearwardly of the selected cervix-simulating apertured element.

The (selected) baby-body-part simulation located as aforesaid may be positioned adjustably with respect to (e.g. may be movable towards and away from) said selected cervix-simulating apertured element.

For example, particularly in the aforesaid second preferred embodiment of the invention, a plurality of different baby-body-part simulations may be provided on a single carrier plate that is rotatably mounted within the chamber in the manner of a turret such as to position selectively any one of its baby-body-part simulations behind the selected cervix-simulating aperture.

Brief Description of the Drawings

By way of example embodiments of this invention will now be described with reference to the accompanying drawings of which:

Figure 1 is a diagrammatic view of a training aid according to a first such embodiment in preparation for use; Figure 2 is a front elevation of the aid of Fig 1, in opened condition;

Figure 3 is a plan view of the aid of Fig 2;

Figure 4 is a perspective view of a part removable from the aid of Figs 1-3;

Figure 5 is a perspective view showing diagrammatically the principal of use of the aid of Figs 1 -3; Figure 6 is a plan view of aid of Figs 1-3 indicating the manner of its use;

Figure 7 is a front view of a training aid according to a second such embodiment;

Figure 8 is a horizontal cross-sectional view of the training aid of Fig 7;

Figure 9 is a partly-broken-away side view of the training aid of Fig 7;

Figure 10 is a front elevation of a part of the training aid of Fig 7; and Figure 11 is a front elevation of the training aid of Fig 7 with forwardly-located parts thereof removed. Detailed Description of Example(s) of the Invention

The utility of the illustrated embodiments of the invention described below is founded on the recognition that, during labour, a woman's cervix dilates and its aperture size expands. The size variation is generally between approximately 1cm to 10cm, and the rate of dilation (i.e. expansion) is generally of the order of lcm/hour. The technique generally employed by a skilled obstetrics practitioner is to insert two fingers in through the vaginal opening and into the cervix, and by spreading the fingers apart, to judge the physical dimension of the cervix. By effecting this size estimation at regular intervals of time, the skilled practitioner can assess the progress of delivery of the baby by the woman. Also, whilst effecting this opening-size estimation, the skilled practitioner can estimate the longitudinal dimension of the woman's cervix or cervical canal which likewise varies during labour, e.g. from 2cms to 4cms approximately at approximately minimum cervical dilation to 0.5cms approximately at maximum dilation.

Furthermore, whilst making this digital assessment, the skilled obstetrics practitioner can feel the part of the baby's body that is pressing against the inner end of the cervix and gauge the baby's position within the womb, e.g. by feeling the cranial fontanelles i.e. depressions of the baby (or the bottom or legs in the event of a prospective breech birth).

Each of the illustrated embodiments of training aid according to this invention allows for its use in effective training in these techniques but without live physical examination of a woman. To this end, each such illustrated embodiment provides a training aid comprising a single housing having a single vagina-simulating opening into its interior, and a plurality of cervix-simulating apertures each selectively positionable behind the vagina-simulating opening. These illustrated embodiments also provide for a plurality of simulations of baby's-body-parts, each such simulation being selectively positionable behind the selected cervix-simulating aperture. The embodiment of obstetrics training aid 10 illustrated in Figs 1 to 6 comprises a cube-like box or housing 12 having a front part 11 and a rear part 13 hinged to one another at 17 and held together, in closed condition, by a toggle catch 18 located at one or each side of the box. The front wall 14 of the front part 11 of box 12 is provided with an opening 15 constructed to simulate a woman's vagina. In this embodiment this construction is provided by two pieces of flexible, preferably resilient, sheet material 16 attached to opposite semi-circular bounding edge portions in the wall 14, the mutually overlapping portions of the pieces 16 being directed inwardly of the box (see Fig 6).

The rearward edge of the front part 11 of box 12 is provided with an uppermost slotlike opening 19 and, coplanar therewith, with a pair of side channels 21 , open towards one another . The slot 19 and channels 21 provide a guide for a plate 20 to be slid into and out of the box. Optionally, the bottom of the box may be provided with a further channel 23, coplanar with side channels 21 and slot 19, and to receive the bottom edge of a plate 20.

The training aid 10 comprises a plurality of such plates 20 of like external dimensions such that any one of them can be selected and slid into or out of the guide provided by slot 19 and side channels 21. Each such plate has a central hole 22 from which a flexible annular ring 24 extends inwardly to define an aperture 25. Conveniently each ring 24 is of resilient, e.g. foam, material and may be bell-shaped (see Fig 5) to simulate a woman's cervical passage. The holes 22 of the several plates 20 may all be of the same size but the rings 24 are arranged to define apertures 25 of differing dimension from one plate 20 to another plate 20. The several rings 24 thereby simulate a cervix at different stages of dilation.

The rear part 13 of box 12 accommodates a removable panel 26 that serves to support a plastics material molding 28 representing or simulating part of a foetal body, e.g. cranium, buttocks, feet or the like. Conveniently a plurality of such panels 26 are provided, each being selectively insertable into rear part 13 of the box (when the latter is open) to present the selected baby-body-part simulation behind the selected cervix- selected simulation 25 in the front part 11 of the closed box. Optionally the panel 26 can be located at a selected one of different positions within box rear part 13, or be slidably movable therein, such as to locate molding 28 at different distances from aperture 25 (when the box is closed).

The obstetrics training aid 10 can be provided with a replaceable patch of latex or other resilient material that is releasable attached, e.g. by a hook-and-loop fastener (such as that available under the Trade mark "VELCRO"), to the front wall 14 and provide a more realistic simulated vaginal opening 15. The arrangement allows a trainee to practice a suturing or episiotomy procedure on the resilient patch, and for the used patch to be replaced.

The obstetrics training aid 10 may be provided with a a further opening adjacent to the vagina-simulating opening, this further opening simulatingthe urethra and enabling the trainee to practice catheterisation.

In use of the training aid 10, the training supervisor (e.g. teacher, examiner or the like)

(a) selects the plate 20 corresponding to the appropriate cervix simulation desired and slides it into position in the front part 11 of the open box 12,

(b) selects the desired panel 26 corresponding to the foetal-body-part simulation that is desired, and inserts that in position in the rear part 12 of box 12,

(c) closes the box, and

(d) invites the trainee to examine the simulated cervix and foetal body part. The trainee then performs an investigation of the simulation. For this he/she inserts his/her fingers into the simulated vaginal opening 15 and into the cervix-simulating aperture 25. By spreading apart his/her fingers the trainee can judge the physical dimension of the selected cervix-simulating aperture 25 and, from this, can assess the stage of progress of real life delivery by a woman in labour. Also the trainee can feel the selected foetal body part simulation 28 and guage the simulated foetal position within the womb. It will be appreciated that, as part of a training programme, several plates 20 - of progressively increasing size of cervix-simulating aperture 25 - would be slidably inserted and removed from box 12 and, following each such insertion, the trainee would perform the investigation described in the previous paragraph. In this way, the trainee can quickly learn how to gauge the degree of cervical dilation and the progress of a live delivery event. In addition several varying forms of presentation of foetal position in the womb can be simulated by changing the selected panels 26 in box 12. For this, instruction is halted as the training supervisor opens the box 12, removes the existing panel 26, replaces it with a different selected panel 26, closes the box, and re- starts the training programme mentioned above.

To avoid the delays in setting up different scenarios for the training program and also to minimise the risk that a trainee might see the selected cervix-simulation and/or the selected foetal-body-part simulation prior to their insertion into box 12, the embodiment of Figs 7 to 11 provides an alternative form of obstetrics training aid.

This alternative embodiment provides a training aid 30 comprising a generally parallelpiped housing 32 having a bottom plate 31 that extends forwardly of the housings front wall 34. A model 33 of a woman's upper legs and lower torso, molded of plastics material, is mounted removably on the front wall 34 and/or plate 31 of the housing 12. The front wall 34 is provided with a vagina-simulating opening 15 provided by flexible material sheets 16, as before. Alternatively, and as is preferred, the vagina-simulating opening 15 may be provided as an orifice within the molding 33 and, in such a circumstance, the orifice may be molded with one or more surface irregularities simulating lesions or other features of gynaecological significance. The latter enable the obstetrics training aid 30 to be used (alternatively or additionally) in training medical personnel in aspects of gynaecology.

For training in aspects of obstetrics however, the interior of housing 12 is provided with a disc 40 (Fig 10) provided with a circular array of holes 42 from each of which a flexible annular ring 44 extends (inwardly of the hole) to define an aperture 45. Each ring 44 is of resilient, e.g. silicone or latex foam, material and may conveniently be bell-shaped to simular a woman's cervical passage. Although the several holes 42 may each be of the same diameter, the several rings 44 are dimensioned to provide apertures 45 of differing sizes to represent a cervix at different stages of dilation.

The outer peripheral edge of disc 40 is provided with a plurality of equi-angularly spaced notches 46, corresponding in number with the number (e.g. five) of cervix- simulating apertures 45 provided on disc 40. These notches 46 are located for selective engagement by a latching roller 47 mounted in the housing 32 that is urged resiliently against the disc's periphery by a spring (see Fig 11). The disc 40 is mounted centrally on a spindle 43 that extends through a bearing in the rear wall of housing 32. A radial lever 49 is coupled to the protruding end of spindle 43 and allows the spindle and disc 40 to be manually rotated (in the manner of turret) and indexed such as to position selectively any one of the cervix-simulating apertures 45 behind the vagina-simulating opening 15.

A similar disc 41 is provided within housing 12 rearwardly of disc 40 and this disc has mounted thereon a plurality of moldings 48 of plastics material, each representing or simulating a different part of a foetus' body. The disc 41 is likewise mounted rotatably on a spindle protruding from the rear of housing 32 where it can be rotated by a radial lever 51. Disc 41 is also provided around its periphery with a plurality of equi- angularly spaced notches 56 located for selective engagement either by the same resiliently urged latching roller 47 that serves to hold the disc 40 in an indexed position, or (as is preferred) by a separate resiliently urged latch 57. By appropriate indexed rotation of disc 41 , any one of the different foetal-body-part simulations 48 can be selected for positioning behind the selected cervix-simulation 45.

Additionally, one or other of the discs 40,41 — preferably disc 40 — can be moved axially to vary the distance between the selected cervix-simulating aperture 45 and the selected foetal-body-part simulation 48 located behind it. Additionally or alternatively, the simulated foetal-body-part 28 or 48 can be rotated to provide a simulation of occipito-posterior, occipito-transverse, and/or other positions of a real foetus.

In one modification of the embodiment of Figs 7-11, the indexed rotation of discs

40,41 is effected electrically, e.g. by a stepping motor, rather than manually. This allows a supervisor or examiner to change training scenarios from a remote location, e.g. for the purposes of a test or examination of the trainee's progress.

Such a motorised version of the training aid 30 can be associated with a suitable data recording device, e.g. a computer, to facilitate monitoring of a trainee's progress. In response to a trainee logging on to the computer or data recording device with his/her personal details (e.g. identification number) for a training session, the data recording device sets parameters for the training aid, e.g. simulated cervical dilation, simulated cervix length and simulated foetal-body-part, appropriate to that trainee and his/her next training session. The trainee makes his/her estimation of cervix diameter and length and keys that information into the data recording device, which computes the accuracy or appropriateness of the keyed-in entries and provides a screen display indicating whether those entries are correct or incorrect. Optionally, the correct dimensions may also be displayed on the screen. Advantageously the data recording device may store the previous 30 to 50 estimations keyed-in by each trainee, and update this record each time a trainee makes his/her estimations. From the thus- updated running record, a chart of the trainee's progress can be obtained.

It will be appreciated that such a 'computerised' arrangement need not be associated solely with a motorised version of the training aid, but can be adopted for a non- motorised manually-changed training aid (such as either embodiment illustrated), it being then necessary for the trainer to input appropriate correct data for each setup prior to the trainee attempting to gauge or estimate the relevant condition or stage of delivery. It will be appreciated that the model 33 of a woman's lower torso and upper legs, that is mounted on the front of the housing 32, can be removed and replaced by an alternative such model — exhibiting a different simulation of a gynaecological condition — that is selected from a plurality of such models each exhibiting different such simulations. Alternatively or additionally, specific simulations of gynaecological features may be provided on one or more of the cervix-simulations 25 or 45.

The body molding 33 of obstetrics training aid 30 can be provided with a replaceable patch of latex or other resilient material that is releasable attached,-e.g. by a hook-and- loop fastener (such as that available under the Trade mark "VELCRO"), to the front lower portion of the molding 33 and such as to provide a more realistic simulated vaginal opening 15. The arrangement allows a trainee to practice a suturing or episiotomy procedure on the resilient patch, and for the used patch to be replaced. Alternatively or additionally, the body molding 33 of obstetrics training aid 30 may be provided with a further opening adjacent to the vagina-simulating opening, this further opening simulatingthe urethra and enabling the trainee to practice catheterisation.

The above-described and illustrated embodiments of the invention may also be modified by the inclusion of inflatable balloons, e.g. of latex rubber, located along the vagina-simlating opening and/or the cervix-simulating aperture to simulate (when inflated) lumps signifying one or more obstetric and/or gynaecological situations.

Alternatively or additionally, the above-described and illustrated embodiments of the invention may include simulations of female pelvis-bony landmarks, e.g. the ischial spines, to aid training a trainee to estimate the descent or station of a real foetal head.

Other modifications and embodiments of the invention will be readily apparent to those skilled in this art, and the particular embodiments hereinbefore described may be varied in construction and detail, e.g. interchanging (where appropriate or desired) different features of each, without departing from the scope of the patent monopoly hereby sought.

Claims

1. An obstetrics training aid characterised by a chamber having: an entrance opening that simulates a vagina; a plurality of apertured elements having differently sized apertures therein in simulation of a cervix and representing the cervix at different stages of dilation; and means within the chamber for positioning behind said vagina-simulating opening a selected one of said cervix-simulating apertured elements.

2. An obstetrics training aid according to Claim 1 characterised in that the vagina- simulating opening is bounded by flexible material to define that opening as an elongate slit.

3. An obstetrics training aid according to Claim 2 characterised in that said flexible material is resilient.

4. An obstetrics training aid according to any one of Claims 1 to 3 characterised in that a wall of the chamber has a slot therein, and in that the plurality of different cervix-simulating apertured elements are provided on a plurality of independent plates of which any one — when selected — can be slid into the chamber through said slot and until its cervix-simulating aperture is located behind the vagina-simulating opening.

5. An obstetrics training aid according to any one of Claims 1 to 3 characterised in that at least some of the plurality of different cervix-simulating apertured elements are provided on a single carrier plate, and in that said carrier plate is rotatably mounted within the chamber in the manner of a turret such as to position selectively any one of its apertured elements behind the vagina-simulating opening.

6. An obstetrics training aid according to any one of Claims 1 to 5 characterised in that the distance between the vagina-simulating opening and the selected apertured element may be varied.

7. An obstetrics training aid according to any one of Claims 1 to 6 characterised in that each said cervix-simulating aperture is of bell-like form.

8 An obstetrics training aid according to any one of Claims 1 to 7 characterised in that the training aid further comprises a simulation of part of the body of a foetus or baby, this baby-body-part simulation being in use located within the chamber rearwardly of the selected cervix-simulating aperture element.

9 An obstetrics training aid according to Claim 8 characterised in that the baby- body-part simulation located as aforesaid is adjustably positionable with respect to said selected cervix-simulating apertured element.

10. An obstetrics training aid according to Claim 8 or Claim 9 characterised in that the baby-body-part simulation located as aforesaid is movable towards and away from said selected cervix-simulating apertured element.

11 An obstetrics training aid according to Claim 8 characterised in that the training aid comprises a plurality of different baby-body-part simulations, and in that any one of said different baby-body-part simulations is selectable for location rearwardly of the selected cervix-simulating apertured element.

12 An obstetrics training aid according to Claim 11 characterised in that the selected baby-body-part simulation located as aforesaid is adjustably positionable with respect to said selected cervix-simulating apertured element.

13. An obstetrics training aid according to Claim 11 or Claim 12 characterised in that the selected baby-body-part simulation located as aforesaid is movable towards and away from said selected cervix-simulating apertured element.

14. A method of training medical personnel in aspects of obstetrics, said method including use of an obstetrics training aid according to any one of Claims 1 to 13.