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. 2025 Nov;132(12):1875-1883.
doi: 10.1111/1471-0528.18332. Epub 2025 Aug 27.

Standardising Simulation-Based Obstetric Emergency Training: A Delphi Consensus Study

Paolo Mannella  1 , Chiara Benedetto  2 , Emilie Canuto  2 , Brigida Carducci  3 , Ilma Floriana Carbone  4 , Elena Cesari  5 , Irene Cetin  4 , Andrea Ciavattini  6 , Nicola Colacurci  7 , Antonella Cromi  8 , Lorenza Driul  9 , Nicoletta Di Simone  10   11 , Sergio Ferrazzani  3 , Tiziana Frusca  12 , Serafina Garofalo  3 , Tullio Ghi  3 , Valentina Giardini  13 , Pantaleo Greco  14   15 , Annalisa Inversetti  10   11 , Antonio Lanzone  3 , Luca Marozio  2 , Carmelinda Martino  3 , Federico Mecacci  16 , Maddalena Morlando  7 , Caterina Neri  3 , Gianluigi Pilu  17 , Federico Prefumo  18 , Giuseppe Rizzo  19 , Giovanni Scambia  3 , Tommaso Simoncini  1 , Emanuela Taricco  19 , Patrizia Vergani  13 , Barbara Zaina  4 , Rossella Nappi  20   21
Affiliations

Standardising Simulation-Based Obstetric Emergency Training: A Delphi Consensus Study

Paolo Mannella et al. BJOG. 2025 Nov.

Abstract

Objective: To develop standardised Objective Structured Assessment of Technical Skills (OSATS) forms for major obstetric emergencies, thereby improving the quality and consistency of obstetric simulation training.

Design and setting: A panel of national experts with extensive experience in teaching Gynaecology and Obstetrics, simulation training, and the clinical management of labour complications and peripartum emergencies.

Population and methods: A Delphi process with four iterative rounds was conducted to create, evaluate, revise, and finalise OSATS checklists for 11 obstetric emergencies. Each OSATS form was rated using a Likert scale (0-9), refined according to expert feedback, and validated through structured discussions.

Main outcome measures: The creation and approval of OSATS forms for shoulder dystocia, vacuum delivery, assisted breech delivery, third- and fourth-degree laceration repair, external cephalic version, abnormal CTG management, postpartum haemorrhage, non-cephalic second twin delivery, reverse breech extraction at caesarean section, maternal collapse and forceps application.

Results: Consensus was achieved for all emergencies with good to excellent ratings: shoulder dystocia (82%), external cephalic version (94%), vacuum delivery (75%), abnormal CTG management (42%), postpartum haemorrhage (96%), reverse breech extraction (72%), maternal collapse (94%), forceps application (76%), non-cephalic second twin delivery (96%), assisted breech delivery (94%) and third- and fourth-degree laceration repair (82%).

Conclusion: The Delphi study successfully developed consensus-based OSATS forms, addressing the need for standardised assessments in obstetric simulation training. These tools enhance training quality, identify skill gaps and improve clinical preparedness. This study was supported by AGUI (Associazione Ginecologi Universitari Italiani).

Keywords: OSATS; emergencies; obstetrics; simulation.

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