Mediolateral episiotomy is performed to reduce the risk of severe perineal tearing during childbirth. Although the procedure is used less frequently than in the past, practitioners still need to perform it correctly when indicated. Current training methods mainly rely on animal tissue, simple low-fidelity models, or expensive commercial simulators. Most existing models do not provide realistic anatomy and tactile feedback or allow training in both episiotomy placement and repair.
This thesis aimed to develop a low-cost, high-fidelity episiotomy trainer that allows practitioners to train both mediolateral episiotomy placement and repair. A literature review and interviews with three gynaecologists and a surgeon were conducted to determine the learning goals, design criteria, and requirements for the phantom. Based on these requirements, five concepts were developed and compared using a Harris profile. The selected concept consisted of two separate silicone phantoms: one for episiotomy placement and one for episiotomy repair. Several prototype iterations were manufactured and evaluated to improve the anatomy, material properties, and manufacturability of the models. 12 gynaecological and obstetric practitioners tested the prototypes during evaluations at a Dutch hospital and a perineal laceration workshop.
The final episiotomy placement phantom allows training of the correct finger position, scissor placement, and incision angle during crowning of the foetal head. The repair phantom includes the skin, vaginal wall, subcutaneous tissue, bulbospongiosus muscle, transverse perineal muscle, anal sphincter, and rectum, allowing participants to practise all essential steps of episiotomy repair. Both models met the predefined learning goals and were designed for local manufacturing at low cost.
The two developed phantoms form a realistic and affordable method for training mediolateral episiotomy placement and its repair. They offer an alternative to existing low-fidelity and high-cost commercial models and can contribute to improving practical training in obstetrics.
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Caesarean section (CS) can be an essential surgical procedure, still maternal and perinatal outcomes after CS remain substantially worse in many low- and middle-income countries (LMICs) as compared to high-income countries. Simulation may complement apprenticeship-based training as it allows trainees to practise procedural steps in a safe environment. However, many commercial CS simulators are too expensive for a low resource setting, and existing low-cost trainers often only address isolated tasks. This project developed a low-cost, modular CS training phantom for practising the procedural sequence from skin incision to uterine closure.

The design builds on the previous Salama CS phantom and adds uterine incision, blunt extension, fetal and placental extraction, and an impacted fetal head scenario. Design requirements and learning goals were set up based on a clinical and design context analysis, and concepts were systematically generated, selected, and improved through iterative prototyping. Selective fidelity was applied: low-cost textiles and foam represented the replaceable abdominal layers, whereas a reinforced silicone strip was used at the lower uterine segment for incision, blunt extension, fetal extraction, and suturing.

Four clinical experts evaluated an initial prototype using a five-point Likert-scale questionnaire and open questions which addressed the ability to practise individual procedural steps, anatomical realism, and educational value. Mean scores ranged from 3.7 to 5.0 for procedural practice, from 4.0 to 5.0 for anatomical realism, and from 4.0 to 5.0 for educational value. Qualitative and quantitative feedback was used for the design of the final prototype which was inspected by two experts who provided qualitative feedback. The final prototype had an estimated one-time material cost of €19.21, which was 80% lower than the €94.02 Salama benchmark, and an estimated recurring material cost of €4.23 per use. These values exclude the externally supplied fetal model and materials obtained from existing workshop stock.

These findings demonstrate the potential of a low-cost, modular training phantom that includes all the major CS steps and an impacted fetal head scenario in supporting safe CS practice. Evidence of learning effectiveness, durability, local manufacturability, and suitability for LMIC implementation requires further validation of the final prototype with the intended trainee population. ... Read more