(1282) Ergonomics for the Obstetrician during Cesarean Delivery

In this prospective cohort study at a single academic center, residents, fellows, and attendings were photographed at skin incision, uterine incision, and skin closure during cesarean delivery. Postures were scored with the Rapid Entire Body Assessment (REBA) and Rapid Upper Limb Assessment (RULA). Poor ergonomics was defined as REBA ≥ 4 or RULA ≥ 5. Risk factors, including patient characteristics, operative phase, and surgeon demographics, were examined. Adjusted relative risks (aRR) with 95 % confidence intervals (CI) were estimated with modified Poisson regression, clustering by surgeon and patient.

Results:
We analyzed 191 photographs from 34 cases involving 37 physicians. REBA classified 47 images (24.6 %) and RULA 104 (54.4 %) as poor. Patient characteristics, operative phase, and surgeon demographics are summarized in Table 1. Poor REBA scores were more likely for primary surgeons (aRR 3.68, 95 % CI 1.78–7.62) and residents (PGY 1–2 aRR 2.90, 95 % CI 1.09–7.74; PGY 3–4 aRR 3.95, 95 % CI 1.62–9.59) and less likely with each 5‑year rise in age (aRR 0.70, 95 % CI 0.62–0.79) or 5‑cm gain in height (aRR 0.75, 95 % CI 0.64–0.87) (Table 2). RULA findings echoed these trends, with age aRR 0.90 (95 % CI 0.85–0.95) and height aRR 0.81 (95 % CI 0.74–0.89) protecting against poor posture.

Conclusion:
Suboptimal posture was pervasive during cesarean delivery, disproportionately affecting younger, shorter, and less‑experienced surgeons. Routine ergonomic monitoring, adjustable operating‑room infrastructure, and simulation-based training should be integrated into obstetric practice to curb cumulative musculoskeletal strain, prolong surgical careers, and sustain high-quality patient care.