Experience and confidence in vaginal twin/breech delivery among trainees and junior specialists in Hong Kong public hospitals Abstract

Ka-Yu CHENG 1, Hoi-Ki CHUNG 2, Catherine MW HUNG 3, Ho-Ying LAW 4, Yuen-Chung TANG 5, Pui-Ying WONG 6, Sani TK WONG 7, Francesca KY LAI 8, Tsz-Kin LO 9
1 Department of Obstetrics and Gynaecology, Princess Margaret Hospital
2 Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital
3 Department of Obstetrics and Gynaecology, Kwong Wah Hospital
4 Department of Obstetrics and Gynaecology, Pamela Youde Nethersole Eastern Hospital
5 Department of Obstetrics and Gynaecology, Tuen Mun Hospital
6 Department of Obstetrics and Gynaecology, United Christian Hospital
7 Department of Obstetrics and Gynaecology, Prince of Wales Hospital
8 Department of Obstetrics and Gynaecology, Queen Mary Hospital
9 Department of Obstetrics and Gynaecology, Princess Margaret Hospital

Objectives: To evaluate the perceived experience and confidence in providing vaginal twin delivery and vaginal breech delivery among obstetric trainees and junior specialists in Hong Kong, and to determine the correlations between the perceived experience and confidence and the numbers of vaginal twin/breech deliveries, forceps deliveries, and rotational operative deliveries performed.
Methods: An anonymous online questionnaire was developed to assess experience and confidence in vaginal twin/breech delivery among trainees and junior specialists in public hospitals. Respondents were asked about the numbers of vaginal twin/breech deliveries, forceps deliveries, and rotational operative deliveries performed. They were asked if they intended to offer vaginal twin/breech delivery in practice. Those who reported insufficient confidence in performing such deliveries were asked for their reasons.
Results: Of 141 eligible respondents, 58 (41.1%) responded. Of them, 52 (40 trainees and 12 junior specialists) were included for analysis. For vaginal twin delivery, the number of procedures performed was correlated with the perceived sufficient experience (r=0.612, p<0.01) and confidence (r=0.586, p<0.01). 12 (23%) respondents reported no sufficient confidence in performing vaginal twin delivery. Reasons provided were lack of training or experience (n=12) and concern about medical legal issues (n=5). 69.2% of respondents intended to offer vaginal twin delivery in practice; the percentage of those with confidence was not correlated with that of those with intention to offer it in practice (r=0.212, p=0.132). For vaginal breech delivery, the number of procedures performed was correlated with perceived sufficient experience (r=0.307, p=0.027) and confidence (r=0.659, p<0.01). 15 (29%) respondents reported no sufficient confidence in performing vaginal breech delivery. Reasons provided were lack of training and experience (n=14) and concern about medical legal issues (n=7). Only 25% of respondents intended to offer vagina breech delivery in practice; the percentage of those with confidence was not correlated with that of those with intention to offer it in practice (r=0.11, p=0.438).
Conclusion: Most respondents did not perceive themselves having sufficient experience and confidence in vaginal twin/breech delivery. The perceived sufficient experience and confidence in vaginal twin/breech delivery was positively correlated to actual clinical experiences. Training of vaginal twin/breech delivery should be provided before these techniques become obsolete.
Hong Kong J Gynaecol Obstet Midwifery 2022; 22(2):73-80
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