title: Does training in obstetric emergencies improve neonatal outcome?
abstract: 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.
authors.affiliation: Women's and Children's Directorate, Southmead Hospital, and Department of Clinical Science at North Bristol, University of Bristol, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Draycott
authors.forename: Thabani
authors.initials: T
authors.lastname: Sibanda
authors.forename: Louise
authors.initials: L
authors.lastname: Owen
authors.forename: Valentine
authors.initials: V
authors.lastname: Akande
authors.forename: Cathy
authors.initials: C
authors.lastname: Winter
authors.forename: Sandra
authors.initials: S
authors.lastname: Reading
authors.forename: Andrew
authors.initials: A
authors.lastname: Whitelaw
mesh_terms: 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