title: Pattern and degree of forces applied during simulation of shoulder dystocia.
abstract: OBJECTIVE
  The objective of the study was to determine the level and pattern of forces applied during simulated shoulder dystocia.
  
  
  METHODS
  One hundred forty staff (95 midwives, 45 obstetricians) were randomized from 6 UK hospitals. Applied delivery force was measured during a standardized simulated shoulder dystocia. Maximum, average, total, and applied force gradients were calculated for each delivery.
  
  
  RESULTS
  There was a wide range for all force variables: geometric mean maximum applied force 106 newtons (N) (range 6 to more than 250, n = 113), maximum force gradient 45 N/s (range 2-249, n = 113), total applied force 2954 N/s (range 33 to 14,197, n = 108), and average applied force 16 N (range 0-68, n = 108).
  
  
  CONCLUSIONS
  Despite participants managing the same scenario, there was great variation in the pattern and degree of traction used. High forces were applied during two thirds of simulations. Training must emphasize that maneuvers should be used to overcome shoulder dystocia while minimizing iatrogenic applied force.
authors: Department of Obstetrics and Gynecology, North Bristol NHS Trust, Southmead Hospital, Bristol, UK. jocrofts@doctors.org.uk
authors: Joanna F
authors: JF
authors: Crofts
authors: Denise
authors: D
authors: Ellis
authors: Mark
authors: M
authors: James
authors: Linda P
authors: LP
authors: Hunt
authors: Robert
authors: R
authors: Fox
authors: Timothy J
authors: TJ
authors: Draycott
mesh_terms: D001917:Brachial Plexus / Q000293:injuries; D004420:Dystocia / Q000628:therapy*; D005260:Female; D006801:Humans; D008348:Manikins; D008880:Midwifery / Q000193:education; D016544:Patient Simulation; D011247:Pregnancy; D012782:Shoulder