Retrospective cohort study of diagnosis-delivery interval with umbilical cord prolapse: the effect of team training.
OBJECTIVE
To determine whether the introduction of multi-professional simulation training was associated with improvements in the management of cord prolapse, in particular, the diagnosis-delivery interval (DDI).


METHODS
Retrospective cohort study.


METHODS
Large tertiary maternity unit within a University Hospital in the United Kingdom.


METHODS
All cases of cord prolapse with informative case record: 34 pre-training, 28 post-training.


METHODS
Review of hospital notes and software system entries; comparison of quality of management for umbilical cord prolapse pre-training (1993-99) and post-training (2001-07).


METHODS
Diagnosis-delivery interval; proportion of caesarean section (CS) in whom actions were taken to reduce cord compression; type of anaesthesia for CS births; rate of low (<7) 5-minute Apgar scores; rate of admission to neonatal intensive care unit (NICU) (if birthweight >2500 g).


RESULTS
After training, there was a statistically significant reduction in median DDI from 25 to 14.5 minutes (P < 0.001). Post-training, there was also a statistically significant increase in the proportion of CS where recommended actions had been performed (from 34.78 to 82.35%, P = 0.003). There was a nonsignificant increase in the use of spinal anaesthesia for CS, from 8.70 to 17.65%, and a nonsignificant reduction in the rate of low Apgar scores from 6.45 to 0% and in the rate of admission to NICU from 38.46 to 22.22%.


CONCLUSIONS
The introduction of annual training, in accordance with national recommendations, was associated with improved management of cord prolapse. Future studies could assess whether this improved management translates into better outcomes for babies and their mothers.
Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK. jsiasakos@gmail.com
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D
Siassakos
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Hasafa
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Sibanda
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Fox
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F
Donald
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Winter
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Draycott
D000773:Anesthesia, Obstetrical / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000706:statistics & numerical data; D004635:Emergency Medicine / Q000193:education; D004739:England; D005260:Female; D006801:Humans; D007318:Inservice Training; D009774:Obstetrics / Q000193:education*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000628:therapy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000592:standards; D011391:Prolapse; D011787:Quality of Health Care; D012189:Retrospective Studies; D013997:Time Factors; D014470:Umbilical Cord