The Gravid Watermelon: An Inexpensive Perimortem Caesarean Section Model
Emergency medicine (EM) residents post-graduate year (PGY) 1-4, obstetrics and gynecology (OB/gyn) Residents PGY 1-4.
The perimortem caesarean section (PCS) is an extremely rare but potentially life-saving procedure for both mother and child. Americans are estimated to have 450,000 cardiac arrests per year.1 Of those, a widely quoted 1/30,000 pregnancies are said to be complicated by cardiac arrest,1,2 with an out-of-hospital arrest occurring in 1.71/100,000 pregnancies.3 Between the years of 2006 and 2012, a New Zealand Maternal Mortality Review Working Group found that 34% of maternal deaths were potentially avoidable, with lack of knowledge and skills quoted as barriers.3 Although EM residents will deliver neonates under ideal conditions on labor and delivery, few, if any, will perform a caesarean section, let alone a PCS. This model was designed be both a cost-effective trainer and a novel approach to teaching. The proposed model builds upon that established by Sampson et al. to be independent of a simulation mannequin; however, it is easily integrated.4
At conclusion of the simulation, participants should be able to: 1) discuss indications for PCS; 2) describe each step to the procedure, and 3) demonstrate ability to perform a PCS on the model.
The gravid watermelon is a cost-effective model that uses common materials from the supermarket and emergency department (ED), using a carved-out watermelon as a base, representing the peritoneal cavity. Inexpensive respiratory tubing is used to represent intestine; watered down gelatin and a small doll in a deflated rubber/plastic ball is used to represent a gravid uterus. The bladder is represented by an unused, water-filled exam glove, and watermelon pulp represents blood clots and mesentery. The gravid watermelon is covered with an elastic bandage to represent tough muscle and fascia, and topped with a shower curtain for skin.
Perimortem caesarian section, C-section, PCS, simulation, task trainer.