Munro Kerr's Operative Obstetrics, 13th Edition

Front Matter
Copyright
Contents
List of Contributors
Acknowledgement
Preface for the 13th Edition of Munro Kerr’s Operative Obstetrics
PART I ANTENATAL
1 - Human Birth
CURRENT UNDERSTANDING
Myometrial Function
The Cervix
BIOLOGICAL CONTROL OF LABOUR – TRIGGERING AND MAINTENANCE
Inflammation and Labour
MEMBRANE RUPTURE
BLIOGRAPHY
2 - Preterm Labour and Delivery
INTRODUCTION
DEFINITION
PRETERM LABOUR VERSUS PRETERM BIRTH
INCIDENCE OF PRETERM BIRTH
AETIOLOGY AND MECHANISMS
RISK FACTORS
OUTCOMES
PREDICTION
DIAGNOSIS
MANAGEMENT
PREVENTION OF PRETERM LABOUR
Reducing Infection
Progesterone
MINIMIZING THE COMPLICATIONS OF PRETERM DELIVERY
Corticosteroids
Magnesium Sulphate
Routine Antibiotics
PRETERM PRELABOUR RUPTURE OF MEMBRANES
Diagnosis
Prognosis and Management
MODE OF DELIVERY FOR PRETERM INFANTS
CONCLUSION
3 - Cervical Cerclage
INTRODUCTION
SURGICAL PROCEDURE
McDonald Cerclage
DISCUSSION
4 - Antepartum Haemorrhage – an Overview
CLINICAL ASSESSMENT
SUMMARY
REFERENCES
5 - Vasa Praevia
INTRODUCTION
DEFINITION
INCIDENCE
PATHOPHYSIOLOGY
DIAGNOSIS
INVESTIGATIONS
MANAGEMENT
REFERENCES
6 - Placental Abruption
RISK FACTORS FOR PLACENTAL ABRUPTION
PATHOPHYSIOLOGY
PRESENTATION AND CLINICAL FEATURES
MANAGEMENT
Initial Assessment
Evidence of Maternal or Fetal Compromise
No Maternal or Fetal Compromise
Preterm Delivery
Conservative Management
Postpartum Care
7 - Induction of Labour
INTRODUCTION
HISTORY
MAKING THE DECISION
INCIDENCE
INDICATIONS
Prevention of Prolonged Pregnancy
Prelabour Rupture of Membranes at Term
Fetal Growth Restriction
Reduced Fetal Movements
Multiple Pregnancy
Suspected Fetal Macrosomia
Maternal Diabetes
Hypertension
Advanced Maternal Age
MATERNAL OBESITY
Obstetric Cholestasis
Antepartum Haemorrhage
Maternal Request
SPECIAL CIRCUMSTANCES
Previous Caesarean Section
Intrauterine Fetal Death
Failed Induction
Previous Failed Induction
Outpatient Induction
METHODS OF INDUCTION
Membrane Sweeping
Prostaglandins
Misoprostol
Mechanical Methods
Amniotomy and Oxytocin
PATHWAY
AUDIT
RISK MANAGEMENT ISSUES
REFERENCES
PART II LABOUR AND DELIVERY
8 - Assessment and Management of Labour
INTRODUCTION
GENERAL PRINCIPLES OF LABOUR
Overview
Antenatal Preparation for Labour
Management of the Labour Ward
Assessment of the Woman Before Labour
Diagnosis of Labour
Care of the Mother and Fetus
Stages of Labour
The Partogram
Personal Attention
NORMAL AND ABNORMAL LABOUR
Dystocia
Inefficient Uterine Action
The Passenger
The Pelvis
DIAGNOSIS AND MANAGEMENT OF POOR PROGRESS IN LABOUR
Prolonged Latent Phase, Primary Dysfunctional Labour and Secondary Arrest
Assessing Progress in Labour
Nulliparous Women
Multiparous Women
RISKS OF TREATMENT WITH OXYTOCIN AND ASSESSMENT OF CONTRACTIONS
THE DURATION OF LABOUR
Contentious Issues
REFERENCES
9 - Fetal Surveillance in Labour
INTERMITTENT AUSCULTATION
HIGH-
Baseline Fetal Heart Rate
Baseline Variability
Accelerations
Decelerations
FETAL BEHAVIOURAL STATE IN THE CARDIOTOCOGRAPH – ‘CYCLING’
IDENTIFICATION OF INDIVIDUAL FEATURES OF CTG TRACE AND THEIR CLASSIFICATION
Classification of the Cardiotocograph3
Sinusoidal Pattern
Blood Group Antibodies That Cross the Placenta
Haemoglobinopathy
Fetal Infection
Fetomaternal Transfusion
MONITORING UTERINE CONTRACTIONS
MECONIUM-
ALTERNATE OR ADJUNCTIVE METHODS OF ASSESSING FETAL HEALTH
Fetal Scalp Blood Sampling
Fetal Scalp Lactate Measurements
Fetal Stimulation Tests
Fetal Pulse Oximetry
INTRAPARTUM MATERNAL PYREXIA AND NEONATAL ENCEPHALOPATHY
CONCLUSIONS
10 - Fetal Asphyxia
HYPOXAEMIA, HYPOXIA AND ASPHYXIA
FHR PATTERNS RELATED TO HYPOXIA AND ACIDOSIS
Acute Hypoxia
Subacute Hypoxia
Gradually Developing Hypoxia
Longstanding Hypoxia
Vascular Ischaemic Injury
CORRELATION OF CTG PATTERNS WITH OBSERVED BRAIN INJURY
FETAL ASPHYXIA AND MEDICOLEGAL IMPLICATIONS
Causation
Liability
REDUCING ADVERSE OUTCOMES
Inappropriate Action
Non-
Record Keeping
Education and Training
Incident Reporting and Audit
CONCLUSIONS
REFERENCES
11 - Acute Tocolysis
INTRODUCTION
DEFINITION
HISTORY
PHARMACOLOGICAL AGENTS FOR ACUTE TOCOLYTICS
CLINICAL INDICATIONS FOR ACUTE TOCOLYSIS
Excessive Uterine Activity
Umbilical Cord Prolapse
Breech Presentation
Intrauterine Manipulation
Acute uterine inversion
Shoulder Dystocia
Retained Placenta
WHICH IS THE IDEAL TOCOLYTIC?
RISK MANAGEMENT AND MEDICOLEGAL ISSUES
REFERENCES
12 - Cord Prolapse
PREDISPOSING FACTORS
Fetal
Maternal
Placental
Amniotic Fluid
Cord
Obstetric Manipulation
DIAGNOSIS
MANAGEMENT
Immediate Relief of Cord Compression
Fetal Assessment
Delay in Transfer of Patient for Delivery
Replacement of Cord
Delivery
13 - The Use of Oxytocin to Accelerate or Induce Labour
OXYTOCIN
PHARMACOKINETICS
HIGH-
CURRENT INTERNATIONAL GUIDELINES
DEVELOPMENT OF GUIDELINES
CLINICAL RISKS
CLINICAL DECISION-
KEY CLINICAL AND ORGANIZATIONAL RECOMMENDATIONS
REFERENCES
14 - Malpresentations and Malpositions
FACE PRESENTATION
Causes
Diagnosis
Management
BROW PRESENTATION
Diagnosis
Management
Transverse Lie
Causes
Diagnosis
Course of Labour
Management
Late Pregnancy Before the Onset of Labour
During Labour With the Fetus Alive
During Labour With the Fetus Dead
COMPOUND PRESENTATION
BIBLIOGRAPHY
15 - Assisted Vaginal Delivery – an Overview
INTRODUCTION
CURRENT PRACTICE
NONROTATIONAL BIRTHS
ROTATIONAL BIRTHS
PRACTICAL ASPECTS OF ASSISTED VAGINAL DELIVERY
Assessment Prior to Assisted Vaginal Delivery
Fetal
Maternal
Descent and Position
Station or Level
Outlet
Low
Mid cavity
Attitude
Synclitism
Caput Succedaneum
Moulding
RISK MANAGEMENT IN ASSISTED VAGINAL DELIVERY
Preprocedure Counselling and Consent
Fetal
Fetal
COMMUNICATION AND DEBRIEFING
GOOD PRACTICE POINTS
SUGGESTED AUDIT TOPICS
REFERENCES
16 - Assisted Vaginal Delivery – Nonrotational Forceps and Manual Rotation
BACKGROUND
Key aspects of preparation
Assembling the Forceps
Application of the Blades
Checking Application
Traction
Removal of the Forceps
Checking for Perineal and Vaginal Trauma
Documentation and Debrief
Sequential Instrumentation
DIGITAL AND MANUAL ROTATION
Technique for Digital Rotation
Technique for Manual Rotation
CONCLUSION
GOOD PRACTICE POINTS
REFERENCES
17 - Assisted Vaginal Delivery – Vacuum
PREPARATION AND TECHNIQUE FOR VACUUM DELIVERY
CUP DETACHMENT
NEONATAL COMPLICATIONS
GOOD PRACTICE POINTS
REFERENCES
18 - Assisted Vaginal Delivery – Rotational Forceps
BACKGROUND
Analgesia and Place of Delivery
Assembling the Forceps
Application of the Blades
Rotation to the Occipitoanterior Position
Traction and Delivery
Removal of the Forceps and Checking for Vaginal and Perineal Trauma
Documentation and Debrief
Rotational Forceps – Other Indications
Avoiding Complications – When to Abandon a Rotational Forceps Delivery
CONCLUSION
GOOD PRACTICE POINTS
REFERENCES
19 - Shoulder Dystocia
DEFINITION
INCIDENCE
RISK FACTORS FOR SHOULDER DYSTOCIA
Macrosomia
Maternal Diabetes Mellitus
Assisted Vaginal Birth
Maternal Obesity
Previous Shoulder Dystocia
Intrapartum Risks
PREDICTION OF SHOULDER DYSTOCIA
PREVENTION
Induction of Labour
Caesarean Section
MANAGEMENT
Recognition of Shoulder Dystocia
Assistance Is Required
State the Problem and Stop the WomanPushing
McRoberts’ Position
Suprapubic Pressure
EVALUATE THE NEED FOR EPISIOTOMY
Internal Manoeuvres
Delivery of the Posterior Arm
Internal Rotational Manoeuvres
All-
Axillary Sling Manoeuvre
Manoeuvres of Last Resort
Zavanelli Manoeuvre
Symphysiotomy
What Not to Do
MANAGEMENT AFTER A SHOULDER DYSTOCIA
Immediate Neonatal Assessment
Maternal Assessment and Treatment
The Baby Should Be Examined for Injury by a Neonatal Clinician
BRACHIAL PLEXUS INJURY
Classification of Brachial Plexus Injury
Erb’s Palsy
Total Brachial Plexus Injury
DOCUMENTATION
RECOMMENDATIONS AND REQUIREMENTS FOR SHOULDER DYSTOCIA TRAINING
REFERENCES
20 - Breech Presentation
Epidemiology
Clinical Features, Diagnosis and Investigations
PREVENTION OF BREECH PRESENTATION: EXTERNAL CEPHALIC VERSION
Success of ECV
Selection for ECV
Method of ECV
Complications of ECV
Prevention of Breech Presentation: Other Manoeuvres
MODE OF BIRTH FOR THE BREECH BABY
Criteria for Safest Vaginal Breech Birth
Counselling, Decision-Makingand Consenting Regarding Mode of Birth
CONDUCT OF VAGINAL BREECH LABOUR
Fetal Monitoring
First and Passive Second Stage of Labour
ACTIVE SECOND STAGE OF LABOUR AND BIRTH
All-FoursPosition: Planned Unassisted Vaginal Breech Birth
Interventions at All-FoursBirth
Semirecumbent Position: Assisted Breech Birth
The Mauriceau–Smellie–Veit Manoeuvre
The Bracht Manoeuvre
Emergency Interventions at Assisted Breech Birth
THE PRETERM BREECH
RISK MANAGEMENT
Organizational Issues
Training in ECV and Vaginal Breech Birth
REFERENCES
21 - Twin and Triplet Delivery
OBSTETRIC FACTORS
Malpresentations
Second Twin
Individual Considerations
Maternal Risks
ANAESTHETIC FACTORS
FIRST STAGE OF LABOUR
SECOND STAGE OF LABOUR
DELIVERY OF THE SECOND TWIN
THIRD STAGE OF LABOUR
LOCKED TWINS
CONJOINED TWINS
TRIPLETS AND HIGHER-ORDER MULTIPLE PREGNANCY
REFERENCES
22 - Labour and delivery after previous caesarean
ONCE A CAESAREAN ALWAYS A CAESAREAN
Type of Uterine Scar
Labour With the Previous Caesarean Section
Uterine Incision Closure
Postoperative Infection
Recurrent Indications for Caesarean Section
Interpregnancy Interval
Twins
External Cephalic Version
More Than One Previous Caesarean Delivery
Measurement of Lower Uterine Segment Thickness
Predicting Adverse Outcomes With Trial for Vaginal Delivery
Hospital Facilities and Personnel
Decision Aids for Mode of Delivery
Cost
MANAGEMENT OF TRIAL FOR VAGINAL DELIVERY
Antenatal Care
Induction of Labour
Labour
CONCLUSIONS
REFERENCES
23 - Uterine Rupture
INTRODUCTION
PATHOPHYSIOLOGY
AETIOLOGY
RISK FACTORS
Myomectomy and Cornual Resection
Metroplasty and Congenital Uterine Anomalies
Trauma
Obstructed Labour
Placenta Accreta Syndrome
CLINICAL FEATURES
MANAGEMENT
Repair
PREVENTION OF UTERINE RUPTURE
PREGNANCY AFTER RUPTURE
Uterine Scar, Prepregnancy Diagnosis and Repair of Caesarean Section Scar Niches
PREGNANCY AFTER RUPTURE
REFERENCES
24 - Caesarean Section: Controversies, Audit, Classification and Indications
CONTROVERSIES
CAESAREAN SECTION AUDIT
TEN GROUP CLASSIFICATION SYSTEM
INDICATIONS FOR CAESAREAN SECTIONS
CLASSIFICATION OF INDICATIONS FOR CAESAREAN SECTIONS
Prelabour
Spontaneous and after induction of labour
ANALYSIS AND INTERPRETATION OF INDICATIONS FOR CAESAREAN SECTIONS
CONCLUSION
25 - Caesarean Section: Procedure
CLASSIFICATION OF URGENCY
PREOPERATIVE PREPARATION
ANAESTHESIA
SURGICAL TECHNIQUES
UTERINE INCISIONS
Low Transverse
Lower Midline
Classical Incision
DELIVERY
CLOSURE
DOCUMENTATION AND PATIENT INFORMATION
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
REFERENCES
26 - Clinical Challenges at Caesarean Section: Uterine Rotation, Transverse Lie and Caesarean at Full Dilatation
INTRODUCTION
CRUCIAL POINTS OF UTERINE ANATOMY AT CS
Development of the Lower Segment
Rotation of the Uterus
Changes in Labour
SURGICAL PRECISION AT CS
Checking and Correcting for Rotation
Delivering the Head
UTERINE ROTATION
CS FOR TRANSVERSE LIE
Transverse Lies Where a Developed Lower Segment Is Likely
Complex Transverse Lies: a Deficient Lower Segment or Membranes Already Ruptured
CAESAREAN SECTION AT FULL DILATATION
PATHOPHYSIOLOGY
CLINICAL HISTORY
CLINICAL EXAMINATION
PROCEEDING TO CS
Difficulty With the Head
DIFFICULTIES ENCOUNTERED/SPECIAL CIRCUMSTANCES
The Head Will Not Disimpact
The Head Still Will Not Disempact
COMPLICATIONS
CONCLUSIONS
AUDIT
REFERENCES
27 - Additional Procedures at Caesarean Section − Salpingectomy, Myomectomy, Ovarian Surgery and Hysterectomy
SALPINGECTOMY
Operative Procedure
MYOMECTOMY
OVARIAN SURGERY
Surgical Procedure
Ovarian Cystectomy
Oophorectomy
OBSTETRIC HYSTERECTOMY
SURGICAL CONSIDERATIONS
Preparation
Incision
Access and Exposure
Surgical Technique
Management of Intraoperative Complications
POSTOPERATIVE CONSIDERATIONS
REFERENCES
28 - Placenta Praevia and the Placenta Accreta Spectrum
PLACENTA PRAEVIA
DIAGNOSIS
ANTEPARTUM MANAGEMENT
Asymptomatic Placenta Praevia
Symptomatic Placenta Praevia
CAESAREAN SECTION FOR UNCOMPLICATED PLACENTA PRAEVIA
VAGINAL DELIVERY IN PLACENTA PRAEVIA
PLACENTAL ACCRETA SYNDROME
Epidemiology
Diagnosis
MANAGEMENT OF PAS CASES
Multidisciplinary Team and Centralization of Services
Hysterectomy
CONSERVATIVE TREATMENTS
Leaving the Placenta In Situ
One-
Triple P Procedure
COMPLICATIONS
POSSIBILITY OF PREVENTION
FUTURE DEVELOPMENTS
REFERENCES
29 - Haemorrhagic Shock, Disseminated Intravascular Coagulation and Obstetric Resuscitation
HAEMORRHAGIC SHOCK
Definition
Incidence
Pathophysiology
Clinical Findings
Diagnosis
DISSEMINATED INTRAVASCULAR COAGULATION
Definition
Incidence
Pathophysiology
Clinical Findings
Diagnosis
OBSTETRIC RESUSCITATION: MOBILIZE, ACT AND THINK
Management of Haemorrhagic Shock and DIC
Audit and Risk Management
REFERENCES
30 - Thromboprophylaxis in Labour and Delivery
INTRODUCTION
INCIDENCE
Anticoagulation Medications in Pregnancy
MANAGEMENT OF THROMBOPROPHYLAXIS FOR LABOUR AND DELIVERY
Delivery Planning
Management of Women on Thromboprophylaxis Who Labour Spontaneously
Management of Women on Prophylactic LMWH Who Undergo Induction of Labour
Management of Women on Thromboprophylaxis Who Undergo Caesarean Section
Management of Women on Thromboprophylaxis Following Delivery
AUDIT AND RISK MANAGEMENT
REFERENCES
31 - Amniotic Fluid Embolism
PATHOPHYSIOLOGY
DIAGNOSIS
MANAGEMENT
REFERENCES
32 - Analgesia and Anaesthesia in Labour and Delivery
INTRODUCTION
PAIN PATHWAYS AND LABOUR
METHODS OF PAIN RELIEF
Nonpharmacological Methods
Prepared Childbirth
Natural Childbirth
Continuous Support
Hypnosis
Transcutaneous Electrical Nerve Stimulation (TENS)
Intradermal Injection of Water
Acupuncture
Pharmacological Methods
First Use of Nitrous Oxide/Oxygen Inhalation Analgesia in Labour
Anaesthesia for Caesarean Section
Neuraxial Anaesthesia for Caesarean Section
General Anaesthesia for Caesarean Section
Local Anaesthesia for Caesarean Section
Anaesthesia for Complications of Vaginal Delivery
Postnatal Analgesia
33 - Labour and Delivery in Women With a High Body Mass Index
INTRODUCTION
DEFINITION
INCIDENCE
HISTORY AND EXAMINATION
Preoperative Patient Assessment
OBSTETRICAL MANAGEMENT
Preoperative Antibiotics
Patient Positioning
Panniculus Retraction and Retractors
Uterine Incision
Subcutaneous Tissue Closure and Subcutaneous Drains
Skin Closure
Wound Vacuum Management
ANAESTHESIA MANAGEMENT
Preoperative Care
Positioning
Monitoring
Aspiration Prophylaxis
Type of Anaesthesia
Regional Anaesthesia
Spinal Catheter Placement
Double Catheter Technique
General Anaesthesia
Airway
Preoxygenation
Induction and Intraoperative Ventilation
Extubation
POSTOPERATIVE ANALGESIA
THROMBOPROPHYLAXIS
SUMMARY
REFERENCES
PART III POSTPARTUM
34 - Postpartum Haemorrhage
INTRODUCTION
DEFINITION
THE NORMAL THIRD STAGE OF LABOUR
PATHOPHYSIOLOGY OF POSTPARTUM HAEMORRHAGE
Uterine Atony
Genital Tract Trauma
Other Causes
MANAGEMENT OF PRIMARY PPH
Oxytocics
Tranexamic Acid
Preparedness for PPH
SECONDARY PPH
Pathophysiology
Management
APPENDIX 1. OXYTOCIC DRUGS
Oxytocin
Ergometrine
Syntometrine
15-­Methyl Prostaglandin F2α
Misoprostol
Carbetocin
REFERENCES
35 - Retained Placenta
INTRODUCTION
ROUTINE MANAGEMENT OF THE THIRD STAGE
Oxytocic Drugs
Cord Clamping
Controlled Cord Traction
Uterine Massage
INCIDENCE OF RETAINED PLACENTA
PATHOPHYSIOLOGY (FIG. 35.2)
HISTORY
EXAMINATION AND INVESTIGATIONS
MANAGEMENT
Technique of Manual Removal
Intraumbilical Vein Injection of Oxytocics
Tocolysis
36 - Uterine and Vaginal Tamponade
UTERINE TAMPONADE
Rationale
Uterine Packing
Balloon Tamponade
Care After Uterine Tamponade
Clinical Efficacy of Uterine Balloon Tamponade
VAGINAL TAMPONADE
REFERENCES
37 - Uterine Compression Sutures
B-
MODIFIED B-
VERTICAL UTERINE SUTURE
SQUARE COMPRESSION SUTURES
COMPLICATIONS AND OUTCOMES
REFERENCES
38 - Pelvic Vessel Ligation and Embolization: Obstetric and Radiological Perspective
HISTORICAL PERSPECTIVE
ANATOMY AND HAEMODYNAMICS
Vascular Anatomy of the Pelvis
Vascular Supply to the Uterus
Uterine Artery Ligation
Ovarian Artery Ligation
Internal Iliac Artery Ligation
RADIOLOGICAL PERSPECTIVE
Types of Haemostatic EndovascularAgents/Devices
EMBOLIZATION
BALLOON OCCLUSION
FUTURE
REFERENCES
39 - Lower Genital Tract Trauma
ANATOMY
PERINEAL TRAUMA
EPISIOTOMY
FIRST DESCRIPTION OF EPISIOTOMY
REPAIR OF PERINEAL TRAUMA
Episiotomy and Second-Degree Tears
Technique
Repair of Episiotomy Dehiscence
OBSTETRIC ANAL SPHINCTER TRAUMA (THIRD AND FOURTH DEGREE TEARS)
Technique
LACERATIONS
Periurethral and Periclitoral Lacerations
Vaginal Lacerations
Cervical Lacerations
Annular Detachment of the Cervix
HAEMATOMAS
Clinical Presentation
Management
REFERENCES
40 - Acute Uterine Inversion
TYPES
Causes
CLINICAL PRESENTATION
Management
RECURRENT UTERINE INVERSION
REFERENCES
41 - Symphysiotomy
INDICATIONS
Cephalopelvic Disproportion
Breech Presentation
Shoulder Dystocia
Maternal Choice/Maternal Health
Disadvantages
Technique
POSTDELIVERY CARE
IMMEDIATE COMPLICATIONS
Haemorrhage
Urinary Complications
Orthopaedic
Symphysiotomy Versus Caesaran Section
CONCLUSION
REFERENCES
42 - Destructive Operations on the Fetus
GENERAL PRINCIPLES
OPERATIVE PROCEDURES
Craniotomy
Craniotomy of the After-
Craniocentesis
Decapitation
Evisceration
Paracentesis
Cleidotomy
POSTDELIVERY CARE
DESTRUCTIVE OPERATIONS VERSUS CAESAREAN SECTION IN LOW-RESOURCESETTINGS
CONCLUSION
REFERENCES
PART IV ORGANIZATIONAL ASPECTS
43 - Perinatal Audit in Labour and Delivery: Safety, Quality and Consistency
INTRODUCTION
MULTIDISCIPLINARY QUALITY ASSURANCE PROGRAMME
AUDIT
INFORMATION COLLECTION
LABOUR EVENTS AND OUTCOME
CLASSIFICATION OF INFORMATION
Principles of Classification of Perinatal Information
TEN GROUP CLASSIFICATION
The Ten Group Classification and the Advantageof Classification
ASSESSMENT OF MANAGEMENT − INTERPRETATION OF INFORMATION
Standardized Classification of Continuous Audit of Labour and Delivery Is Required to Assess Care
The TGCS: A New Way of Thinking15
Modification of Management
REFERENCES
44 - Competence and Skills Training
INTRODUCTION AND HISTORICAL CONTEXT
PREVENTABLE HARM
SKILLS TRAINING
KEY ELEMENTS FOR SKILLS TRAINING
Simulation
High Fidelity
Local Teamworking
Leadership – Roles and Responsibilities
Communication and Nontechnical Skills
HOW TO ORGANIZE SKILLS TRAINING
Workstations
Setting Up
Background
Demonstration
Practice
Scenario-Based Stations
Setting Up
Briefing Participants (Where/Who/What/How)
Run the Scenario
Facilitated Debrief
Competence
Using targeted outcomes
Training in Low-Resource Settings
CONCLUSION
REFERENCES
Index