Kobe University Repository : Kernel タイトル Evaluation of midwife’s vaginal examination by virtual reality model Title 著者 Ogahara, Miyuki / Saito, Izumi Author(s) 掲載誌・巻号・ページ Bulletin of health sciences Kobe,32:17-32 Citation 刊行日 2016 Issue date 資源タイプ Departmental Bulletin Paper / 紀要論文 Resource Type 版区分 publisher Resource Version 権利 Rights DOI JaLCDOI 10.24546/81009755 URL http://www.lib.kobe-u.ac.jp/handle_kernel/81009755 PDF issue: 2021-10-07 Evaluation of midwife’s vaginal examination by virtual reality model Miyuki Ogahara1, Izumi Saito2 Abstract The objectives of this study were to determine the vaginal examination techniques used by midwives through measurements with objective indicators; to determine the relation between midwives' vaginal examination techniques, number of years of work experience, and number of years of providing birth assistance; and to provide basic data for the development of an educational model of noninvasive vaginal examination. The study was conducted on 103 midwives working in hospitals. An actual measurement of five items (Cervical dilatation, position of the cervix, cervical consistency, cervical effacement, and station of the presenting fetal head) involved in vaginal examination was performed by using the first virtual-reality model of vaginal examination developed in Japan. The accuracy rate of the vaginal examination based on the total score was 57.8%. Of the five evaluation items, the “station of the presenting fetal head” had the lowest accuracy rate. No relationship was found between the total scores of vaginal examination techniques, the midwives' clinical experience, and the number of births they had assisted. This study will serve as basis for constructing basic data for practical use in an educational system for the learning and mastery of diagnostic skills. Keywords vaginal examination, evaluation, technique, midwife, virtual-reality model 1 Kobe University Graduate School of Health Sciences, Japan 2 Department of Nursing, Kobe University Graduate School of Health Sciences 17 Miyuki Ogahara et al Introduction In addition, a study conducted on obstetricians, who compared the findings of vaginal Vaginal examination is one of the basic evaluation procedures performed in the field of examination with transabdominal ultrasonographic examination-based diagnosis, provided obstetrics and gynecology, and has an important role in medicine and health care. However, it evidence that the rate of erroneous judgments was 40%–60%, and that transabdominal is a physically and mentally invasive procedure as it involves direct contact with female ultrasonographic examination-based diagnosis was associated with a lower rate of erroneous 5) 6) genitalia. Vaginal examination is conducted during medical consultations and should be judgments than vaginal examination . However, transabdominal ultrasonographic performed only by fully trained and nationally certified midwives and physicians with a high examination-based diagnosis has also been reported to have its own limitations at some stages 7) level of knowledge and skills (Notification from the Head of the Health Policy Bureau, in the progression of delivery . In Japan, a comparative study of diagnoses made by Ministry of Health, Labour and Welfare, 2004). Meanwhile, it is commonly agreed that in midwives on the basis of vaginal examination and those based on transabdominal 8) perinatal care, vaginal examination is an essential procedure for the assessment of progression ultrasonographic examination was reported in 2010 . With vaginal examinations, the rate of of labor. Vaginal examination of parturient women allows for the observation of the (1) degree erroneous judgments was 59.7%, showing virtually the same performance as that reported in of dilatation of the cervical canal, (2) position of the cervical canal, (3) hardness of the cervical previous studies. However, previous reports have shown that cases where in the fetus weigh canal, (4) cervical effacement, (5) height and station of the fetal head, (6) presenting part of the 2500 g, and in which the cervical dilation is 7 cm, transabdominal ultrasonographic fetus, and (7) degree of rotation of the fetus. For items [1] to [5], the Bishop pelvic score is examination-based measurements may not be accurate, and along with the progression of used for the scoring of cervical ripening. The Bishop pelvic score is a universal and important delivery, there may be limitations to the transabdominal ultrasonographic examination-based parameter in the clinical setting, used as a standard criterion for judging a ripened cervix; in assessment of the cervix. In addition, it is mentioned that there is no significant difference in other words, it is used as a reference for assessing the progression of labor. In actual the accuracy of vaginal examination techniques according to the midwives' clinical experience monitoring and follow-up of a delivery, it is important that vaginal examination will be and number of assisted births. In other words, no alternative to vaginal examination exists repeated a number of times and that the changes will be monitored in a time-course manner anywhere in the world, and therefore, it would not be an exaggeration to say that vaginal through comparison of findings, in order to ensure a safe delivery. However, because of the examination techniques are of higher importance in the diagnosis of the progression of particularities of the procedure as described above, avoiding unnecessary vaginal examinations delivery. On the basis of such a background, studies on vaginal examinations, as well as on the has become common sense in modern perinatal care. education, clinical training, and field learning of vaginal examination techniques, are faced Furthermore, with future progress in midwife-and-obstetrician-led shared examinations with considerable restrictions, including challenges to the accuracy of diagnosis, to the rate of and midwife-managed delivery units, midwives will be more proactively involved in assisting erroneous judgments among obstetricians and midwives while performing vaginal deliveries, and proficient skills in vaginal examination techniques will be essential for an examination, and to the comparison of findings from vaginal examination with those from accurate diagnosis of the progression of delivery and for minimizing physical and other diagnostic procedures. psychological pain in parturient women. Moreover, there will be a need for biological models This is a considerable issue in ensuring a safe delivery in accordance with the compensating for the decrease in opportunities to acquire skills in conducting diagnosis expectations of parturient women, fetuses, neonates and family members, as well as the entire through vaginal examination. In studies conducted in other countries on the accuracy of nation. In addition, from the perspective of educational background, the existing education of vaginal examination techniques in the assessment of progression of delivery, the rates of physicians and midwives on vaginal examination has been entrusted to educational misjudgments among obstetricians and midwives were analyzed using a cervical dilation institutions, and there is a lack of quality educational materials. For this reason, it is believed model simulator, and the results showed that the rate of erroneous judgments by both that clinical training supervisors teach students about vaginal examination based on what they obstetricians and midwives was approximately 51.4%, and that no significant differences in have learned through experience. Because the vaginal examination technique cannot be vaginal examination techniques were found between the two professions 1) 2) 3) 4). visualized while being performed, it is impossible for a third party to check or confirm a 18 Bulletin of Health Sciences Kobe Evaluation of midwife’s vaginal examination by virtual reality model Introduction In addition, a study conducted on obstetricians, who compared the findings of vaginal Vaginal examination is one of the basic evaluation procedures performed in the field of examination with transabdominal ultrasonographic examination-based diagnosis, provided obstetrics and gynecology, and has an important role in medicine and health care. However, it evidence that the rate of erroneous judgments was 40%–60%, and that transabdominal is a physically and mentally invasive procedure as it involves direct contact with female ultrasonographic examination-based diagnosis was associated with a lower rate of erroneous 5) 6) genitalia. Vaginal examination is conducted during medical consultations and should be judgments than vaginal examination . However, transabdominal ultrasonographic performed only by fully trained and nationally certified midwives and physicians with a high examination-based diagnosis has also been reported to have its own limitations at some stages 7) level of knowledge and skills (Notification from the Head of the Health Policy Bureau, in the progression of delivery . In Japan, a comparative study of diagnoses made by Ministry of Health, Labour and Welfare, 2004). Meanwhile, it is commonly agreed that in midwives on the basis of vaginal examination and those based on transabdominal 8) perinatal care, vaginal examination is an essential procedure for the assessment of progression ultrasonographic examination was reported in 2010 . With vaginal examinations, the rate of of labor. Vaginal examination of parturient women allows for the observation of the (1) degree erroneous judgments was