The Boggy Uterus: How Simulation Offers Effective PPH Management Training

| Roxanne Blanford

Uterine atony is defined as failure of the myometrium to contract and retract around the open blood vessels of the uteroplacental implantation site following childbirth. Myometrial contractions are vital to safeguard against excessive (and, potentially fatal) blood loss. 

Simulation-based training and education in the management of labor and delivery emergencies may be beneficial in creating skilled healthcare providers who are ready and able to effectively handle such occurrences for improved patient safety and outcomes. 

A hypotonic uterus, or "boggy" uterus, is among the most common obstetrical conditions which may cause postpartum infection and postpartum hemorrhage (PPH). But prompt recognition of the problem, and effective management with uterine massage, uterotonic drugs, and/or other crucial interventions, can arrest post-delivery bleeding.

But if the urgent obstetrical situation is mishandled, or if the response is not well-timed, the ensuing result can be traumatic. Delays in establishing an accurate diagnosis, failing to perform adequate maneuvers and/or employing poor team communication strategies may lead to catastrophic patient outcomes.

Proper training of obstetric medical personnel in managing complications associated with uterine atony and PPH is essential.


In obstetrics and gynecology, simulation can address key dimensions of clinical training, technical skills, and management of a range of medical emergencies.

From demonstrating competence in establishing pneumoperitoneum safely, and demonstrating leadership skills during a simulated crisis at the simulation center, to in-situ drills at the hospital, simulation is now considered an essential part of maternity care training.


Strengthening PPH Managment Skills Through Simulation Training

Subpar patient care for PPH can result in maternal death. Drills to enhance the management of maternal hemorrhage have been recommended by the Joint Commission on Accreditation of Healthcare Organizations,** suggesting that simulation-based practice in obstetrical emergencies can go a long way towards improving clinical performance and patient safety during real-life situations.

With the Lucina childbirthing patient simulator, learners may obtain realistic hands-on training in managing PPH occurrences by developing and strengthening their skills in

  • identifying an over-distended uterus
  • detecting and responding to a boggy uterus and/or an inverted uterus
  • recognizing and quantifying excessive post-delivery blood loss 
  • applying bimanual compression and uterine massage
  • using an intrauterine balloon tamponade

CAE Lucina’s vaginal bleeding reservoir holds two liters of fluid and the simulator's blood loss is modeled on true physiology. Appropriate changes occur in Lucina’s heart rate, blood pressure, and respiratory parameters for a more realistic training experience in obstetrical emergencies, such as postpartum hemorrhage management with a boggy uterus.

CAE Lucina: An Exceptional Childbirth Simulator

For all the stages of labor and delivery, the wireless CAE Lucina maternal-fetal simulator provides medical procedural practice of the highest caliber. Lucina amazes with every detail, including a lifelike birthing fetus with no connection ports. The simulator comes complete with a variety of delivery training scenarios -- including shoulder dystocia and breech delivery.

With 5 pre-configured Simulated Clinical Experiences (SCEs), Lucina allows instructors to increase throughput and manage multiple demands effortlessly with positive results.

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