Design of a Serious Game for Handling Obstetrical Emergencies.

BACKGROUND: The emergence of new technologies in the obstetrical field should lead to the development of learning applications, specifically for obstetrical emergencies. Many childbirth simulations have been recently developed. However, to date none of them have been integrated into a serious game. OBJECTIVE: Our objective was to design a new type of immersive serious game, using virtual glasses to facilitate the learning of pregnancy and childbirth pathologies. We have elaborated a new game engine, placing the student in some maternity emergency situations and delivery room simulations. METHODS: A gynecologist initially wrote a scenario based on a real clinical situation. He also designed, along with an educational engineer, a tree diagram, which served as a guide for dialogues and actions. A game engine, especially developed for this case, enabled us to connect actions to the graphic universe (fully 3D modeled and based on photographic references). We used the Oculus Rift in order to immerse the player in virtual reality. Each action in the game was linked to a certain number of score points, which could either be positive or negative. RESULTS: Different pathological pregnancy situations have been targeted and are as follows: care of spontaneous miscarriage, threat of preterm birth, forceps operative delivery for fetal abnormal heart rate, and reduction of a shoulder dystocia. The first phase immerses the learner into an action scene, as a doctor. The second phase ask the student to make a diagnosis. Once the diagnosis is made, different treatments are suggested. CONCLUSIONS: Our serious game offers a new perspective for obstetrical emergency management trainings and provides students with active learning by immersing them into an environment, which recreates all or part of the real obstetrical world of emergency. It is consistent with the latest recommendations, which clarify the importance of simulation in teaching and in ongoing professional development.

[Genital prolapse surgery: state of the art of the vaginal approach]. / Le prolapsus génital état des lieux de la chirurgie par voie vaginale.

Treatment of genital prolapse is mainly surgical. The vaginal approach is a shorter procedure than the abdominal approach with a quicker resumption of activity for the patients. We describe different techniques which are most often performed in our daily practice. For the complete prolapse affecting the three components of the pelvic floor, we most often associate a colpohysterectomy, a native tissue reinforcement for the treatment of cystocele, sub-symphyseal crossing of the uterosacral ligaments using the technique of Campbell and finally a suspension of the vaginal vault according to Richter with a levator myorraphy. Currently, native tissues used in these techniques tend to be superseded in our service by reinforcement prosthetic implants, which according to the latest French Health Higher Authority guidelines (November 14, 2007) "could be of interest in relapse surgery, if a clinical element raises fears of high risk of recurrence." In any case, patients seeking a surgical treatment of their genital prolapse must be fully informed of the specific risk related to each technique. They must also be informed of the long-term results or of the lack of available data, regarding techniques using native tissue or prostheses.

Maternal anxiety and pain during prenatal diagnostic techniques: a prospective study.

OBJECTIVE: To explore anxiety and pain felt by women undergoing chorionic villus sampling (CVS) and amniocentesis (AC). METHOD: We prospectively questioned 254 women (67 undergoing CVS, 187 AC) before the procedure on their anxiety, after the procedure on their pain felt, and the support they received or desired. The medical team collected technical information concerning each procedure. RESULTS: The level of anxiety was significantly higher in women undergoing CVS than AC, in those who had received complete information before the procedure, and when indication for the procedure was fetal structural abnormalities. The level of pain was significantly higher in cases of anxious women, those undergoing a CVS rather than AC, those who had undergone invasive prenatal diagnostic procedures in previous pregnancies, in procedures deemed difficult by the operator, and with needle insertion in the lateral part of the uterus. About 30% of women undergoing CVS and 8% of those undergoing AC would have desired some form of pain prevention, mostly with nonpharmacologic therapy. CONCLUSION: Prenatal diagnosis is frequently associated with anxiety and pain. We identified factors that could exacerbate either one. When questioned, patients would desire a nonpharmacologic means for pain prevention.