Comparing Low-Fidelity and High-Fidelity Simulation to Standard Training in Obstetric Emergencies: A Systematic Review

Background: Simulation-based training is increasingly used to enhance clinical competence in obstetric emergencies, yet evidence comparing high- and low-fidelity simulation against standard training remains fragmented. Objectives: To systematically evaluate the effectiveness of high-fidelity and low-fidelity simulation-based training compared with standard non-simulation training in improving knowledge, clinical skills, confidence, teamwork and communication among healthcare professionals managing obstetric emergencies. Search strategy: A comprehensive search of PubMed, Cochrane CENTRAL, Embase and Scopus was conducted from inception to 30 May 2025. Reference lists of relevant studies were also screened. Selection criteria: Randomised controlled trials (RCTs) or quasi-RCTs comparing high- or low-fidelity simulation with standard training for obstetric emergencies were eligible. Studies had to report at least one quantitative outcome related to knowledge, skills, confidence, teamwork, communication or patient outcomes. Data collection and analysis: Two reviewers independently screened, extracted data and assessed risk of bias using the Cochrane RoB 2.0 tool. Due to substantial heterogeneity in study design, populations and outcomes, results were narratively synthesised. Main results: Sixteen RCTs including 1,453 participants met the inclusion criteria. Eleven studies evaluated high-fidelity simulation; five examined low-fidelity simulation. Most studies demonstrated significant improvements in knowledge acquisition, clinical skills, confidence and teamwork compared to standard training. High-fidelity simulation was generally associated with greater improvements than low-fidelity approaches. Risk of bias was predominantly low, with some concerns for selective reporting. Conclusions: Simulation-based training, particularly high-fidelity modalities, appears to enhance learning and performance in obstetric emergencies compared with standard training. Further research should address long-term retention, patient-centred outcomes and cost-effectiveness.