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Cureus. 2017 Jul 25;9(7):e1513. doi: 10.7759/cureus.1513.

Autonomic Dysreflexia in the Peripartum Patient: A Multidisciplinary and Interprofessional Simulation Scenario.

Author information

Department of Anesthesiology and Pain Medicine, The Ottawa Hospital / University of Ottawa.
Department of Obstetrics & Gynecology, The Ottawa Hospital / University of Ottawa.
Department of Obstetrics & Gynecology, University of Calgary.
Department of Innovation in Medical Education, University of Ottawa.


This case is one of an eight-case multidisciplinary curriculum designed and implemented at the University of Ottawa by simulation educators with specialty training in obstetrics and gynecology (ob/gyn) and anesthesiology. Consultation with a nurse educator maintained quality and relevance of objectives for nursing participants. The curriculum was prepared to train ob/gyn and anesthesiology residents and nurses to hone crisis resource management skills and to recognize and manage rare/critical medical events in an obstetrical setting. Obstetricians, anesthesiologists, and nurses often work together in acute, high-stakes situations and this curriculum provides a safe environment to practice team-based management of such emergencies. Over an eight-year period, this curriculum has been executed in scenario couplets on a four-year cycle to allow ob/gyn and anesthesiology residents exposure to all scenarios during a five-year residency beginning in their second year. Prospective evaluation data has been positive. For example, over 90% of participants rated these simulations to be 5 out of 5 for "Was an effective use of my educational time" and "Will influence/enhance my future practice". In this scenario, participants must recognize and manage a parturient with spinal cord injury in active labour who develops autonomic dysreflexia. The fetal heart tracing becomes abnormal and the team must respond with urgent delivery. This scenario requires a mannequin for a pelvic exam and a pregnant abdomen. This simulation case includes a case template, critical actions checklist, debriefing guide, summary of key medical content, and an evaluation form for learners to provide feedback.


anesthesiology; crisis resource management; nursing; obstetrics and gynecology; postgraduate medical education; simulation scenario

Conflict of interest statement

The authors have declared that no competing interests exist.

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