Does training in obstetric emergencies improve neonatal outcome?
OBJECTIVE
To determine whether the introduction of Obstetrics Emergency Training in line with the recommendations of the Clinical Negligence Scheme for Trusts (CNST) was associated with a reduction in perinatal asphyxia and neonatal hypoxic-ischaemic encephalopathy (HIE).


METHODS
A retrospective cohort observational study.


METHODS
A tertiary referral maternity unit in a teaching hospital.


METHODS
Term, cephalic presenting, singleton infants born at Southmead Hospital between 1998 and 2003 were identified; those born by elective Caesarean sections were excluded.


METHODS
Five-minute Apgar scores were reviewed. Infants that developed HIE were prospectively identified throughout this period. The study compared the period 'pre-training' (1998-1999), with the period 'post-training' (2001-2003).


METHODS
Five-minute Apgar scores and HIE.


RESULTS
Infants (19,460) were included. Infants born with 5-minute Apgar scores of <or=6 decreased from 86.6 to 44.6 per 10,000 births (P<0.001) and those with HIE decreased from 27.3 to 13.6 per 10,000 births (P=0.032) following the introduction of the training courses in 2000. Antepartum and intrapartum stillbirth at term rates remained unchanged, at about 15 and 4 per 10,000 births, respectively.


CONCLUSIONS
The introduction of obstetric emergencies training courses was associated with a significant reduction in low 5-minute Apgar scores and HIE. This improvement has been sustained as the training has continued. This is the first time an educational intervention has been shown to be associated with a clinically important, and sustained, improvement in perinatal outcome.
Draycott
Tim
T
Women's and Children's Directorate, Southmead Hospital, and Department of Clinical Science at North Bristol, University of Bristol, UK.
Sibanda
Thabani
T
Owen
Louise
L
Akande
Valentine
V
Winter
Cathy
C
Reading
Sandra
S
Whitelaw
Andrew
A
D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000517:prevention & control*; D015331:Cohort Studies; D004635:Emergency Medicine / Q000193:education*; D005260:Female; D005313:Fetal Death; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000517:prevention & control*; D007231:Infant, Newborn; D009774:Obstetrics / Q000193:education*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012189:Retrospective Studies; D050497:Stillbirth