Evaluation of Surgical Skills and Decision-Making in Obstetric Haemorrhage Management Among Registrars in South West Nigeria

Obstetric haemorrhage remains the leading cause of maternal death in Nigeria, with timely and skilled surgical intervention a critical determinant of survival. This study evaluates obstetric haemorrhage management surgical skills and clinical decision-making among obstetrics and gynaecology registrars at teaching hospitals in the South West geopolitical zone. A structured simulation-based assessment was conducted with 30 obstetrics and gynaecology registrars at Obafemi Awolowo University Teaching Hospital, University of Ibadan, and Lagos State University Teaching Hospital. Registrars were assessed on recognition of major obstetric haemorrhage, resuscitation initiation, uterotonic selection and dosing, surgical intervention decision-making, and team communication using validated haemorrhage simulation scenarios. Overall competency was rated adequate in only 53 percent. Decision to proceed to surgical intervention (B-Lynch suture or hysterectomy) was appropriately timed in 60 percent of simulation encounters. Blood product ordering and documentation was deficient in 47 percent. Team communication under simulated crisis conditions was rated poor in 38 percent. The study identifies significant competency gaps in haemorrhage management among South West registrars. Professional recommendations include mandatory structured obstetric haemorrhage simulation training, haemorrhage bundle protocol adoption, and regular multidisciplinary drills as training programme requirements for obstetrics and gynaecology residency in South West Nigerian teaching hospitals. Keywords: obstetric haemorrhage, surgical skills, registrar training, simulation, South West Nigeria