Improving neonatal outcome through practical shoulder dystocia training.
OBJECTIVE
To compare the management of and neonatal injury associated with shoulder dystocia before and after introduction of mandatory shoulder dystocia simulation training.


METHODS
This was a retrospective, observational study comparing the management and neonatal outcome of births complicated by shoulder dystocia before (January 1996 to December 1999) and after (January 2001 to December 2004) the introduction of shoulder dystocia training at Southmead Hospital, Bristol, United Kingdom. The management of shoulder dystocia and associated neonatal injuries were compared pretraining and posttraining through a review of intrapartum and postpartum records of term, cephalic, singleton births in which difficulty with the shoulders was recorded during the two study periods.


RESULTS
There were 15,908 and 13,117 eligible births pretraining and posttraining, respectively. The shoulder dystocia rates were similar: pretraining 324 (2.04%) and posttraining 262 (2.00%) (P=.813). After training was introduced, clinical management improved: McRoberts' position, pretraining 95/324 (29.3%) to 229/262 (87.4%) posttraining (P<.001); suprapubic pressure 90/324 (27.8%) to 119/262 (45.4%) (P<.001); internal rotational maneuver 22/324 (6.8%) to 29/262 (11.1%) (P=.020); delivery of posterior arm 24/324 (7.4%) to 52/262 (19.8%) (P<.001); no recognized maneuvers performed 174/324 (50.9%) to 21/262 (8.0%) (P<.001); documented excessive traction 54/324 (16.7%) to 24/262 (9.2%) (P=.010). There was a significant reduction in neonatal injury at birth after shoulder dystocia: 30/324 (9.3%) to 6/262 (2.3%) (relative risk 0.25 [confidence interval 0.11-0.57]).


CONCLUSIONS
The introduction of shoulder dystocia training for all maternity staff was associated with improved management and neonatal outcomes of births complicated by shoulder dystocia.


METHODS
II.
Draycott
Timothy J
TJ
Department of Obstetrics and Gynaecology, North Bristol NHS Trust, Southmead Hospital, Bristol, UK. tdraycott@gmail.com
Crofts
Joanna F
JF
Ash
Jonathan P
JP
Wilson
Louise V
LV
Yard
Elaine
E
Sibanda
Thabani
T
Whitelaw
Andrew
A
D001720:Birth Injuries / Q000517:prevention & control*; D016022:Case-Control Studies; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods*; D004420:Dystocia / Q000628:therapy*; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008348:Manikins; D010291:Paresis / Q000517:prevention & control; D011247:Pregnancy; D012189:Retrospective Studies; D012782:Shoulder / Q000294:innervation; D000070599:Shoulder Injuries; D014710:Version, Fetal / Q000193:education / Q000379:methods