How to Create a Bleeding Uterus and Abdominal Skin Overlay for C-Section Simulations

10/22/2018

By Paul Ferguson, Mater Education Brisbane Australia

Fig A Abdominal Wall                                        Fig B Uterus

Mater Education's simulation team created a multi-purpose silicone based abdominal layer which was used to train the obstetric team to deliver a deeply impacted head and manage a postpartum haemorrhage during a caesarean section. The delivery of an impacted fetal head at caesarean section is difficult, stressful and traumatic, thus training is required to rehearse this skill. Using simulation to practice this required the development of a specific abdominal model that could hold a baby, be cut, bleed and be sutured. The faculty of the Advanced Maternity Emergency Management (A-MEM) program tasked the technical team to create an inexpensive and realistic task trainer suitable for simulating an emergency caesarean section of an impacted head.

The abdominal layer pictured in Fig A, was made from a two part silicone mix, which was combined with several layers to create a finished product.  We use a product called Barnes Platsil Gel-10, although other silicone products like Dragon Skin would work just as well.  During the mixing phase of the silicone, we add red acrylic paint, which can be sourced from any art shop, and Fuse Fx silicone pigment. This is mixed to give the silicone a skin like look. 

We recommend using a vacuum pump to remove air from the silicone mixture. If you plan to use a vacuum pump you will need to add a retarder to the silicone mixture to prolong the setting time of the mix.  We used Barnes Platsil 71R retarder.  This step is not a necessity, but if completed the end product has a better look, texture and strength.    

Step 1 -

The silicone mixture was poured onto a Vaseline covered metal surface (an industrial kitchen skin works well) then the mix is spread out to form a rectangular shape.  We aimed to have a thickness of around 3mm for the top skin layer.  On the underside of the skin layer, we created a pocket with a small amount of leftover silicone.  The thickness of this layer is less than 1mm.  The pocket held a small amount of fake blood; this was done to add a higher degree of realism to the simulation.  Video 1 below shows a similar effect that we used for a tracheostomy sim. 

Step 2 -

We applied some cushion foam to the underside of the skin layer to mimic the fat layer.  This can be glued to the silicone with more silicone.  Below the foam/fat layer, we attached a white layer of silicone mixture, prepared in the same manner as the skin layer and attached to the other side of the foam with more silicone.   

Step 3 -

The final step was making a lifelike uterus (Fig B).  This was made with silicone in two parts.  We created  two identical pear shaped layers, and once both layers were dry, we used silicone and sutures to merge both sides together to make a watertight seal, which allowed us to put a small bag of blood inside to add more fidelity to the simulation. 

The final product was laid over the manikin’s abdominal cavity, with a manikin baby inside.  Video 2 below shows the simulation procedure.