The Effect of surgeon-performed preincision ultrasound on surgeons’ anxiety and confidence before cesarean delivery

Objective: To evaluate the effect of preincision surgeon-performed ultrasound before cesarean delivery on anxiety and confidence among residents and attending obstetricians. Methods: In this prospective observational study, elective cesarean deliveries were performed with or without preincision ultrasound in an alternating manner. Residents served as primary surgeons under attending supervision. Surgeons completed postoperative questionnaires assessing anxiety, confidence, and perceived ultrasound utility. Results: A total of 95 elective cesarean deliveries were included, generating 178 physician observations from 26 residents and 24 attending obstetricians. The study group was thus subdivided into four groups according to seniority and the use of preincision ultrasound; (1) residents using ultrasound (n = 51, 28.7%), (2) residents without ultrasound (n = 41, 23%), (3) attending obstetricians using ultrasound (n = 48, 27.0%), and (4) attending obstetricians not using ultrasound (n = 38, 21.3%). Overall, residents reported significantly higher anxiety levels than attending obstetricians. Incorporation of preincision ultrasound was not associated with reduced anxiety or improved surgical confidence among either residents or obstetrical attendings. However, residents who used ultrasound reported greater perceived availability of necessary preoperative information compared with those who did not. Ultrasound was rated as significantly more helpful by residents than by attendings in assisting during surgery, increasing confidence, improving perceived performance, and aiding in planning fetal extraction. Conclusions: Surgeon-performed preincision ultrasound was not associated with reduced anxiety or improved surgical confidence. Residents reported greater perceived benefit than attending obstetricians, suggesting a potential role for ultrasound in supporting preoperative planning among less experienced surgeons.