title: Prevention of brachial plexus injury-12 years of shoulder dystocia training: an interrupted time-series study.
abstract: OBJECTIVE
  To investigate management and outcomes of incidences of shoulder dystocia in the 12 years following the introduction of an obstetric emergencies training programme.
  
  
  METHODS
  Interrupted time-series study comparing management and neonatal outcome of births complicated by shoulder dystocia over three 4-year periods: (i) Pre-training (1996-99), (ii) Early training (2001-04), and (iii) Late training (2009-12).
  
  
  METHODS
  Southmead Hospital, Bristol, UK, with approximately 6000 births per annum.
  
  
  METHODS
  Infants and their mothers who experienced shoulder dystocia.
  
  
  METHODS
  A bi-monthly multi-professional 1-day intrapartum emergencies training course, that included a 30-minute practical session on shoulder dystocia management, commenced in 2000.
  
  
  RESULTS
  Neonatal morbidity (brachial plexus injury, humeral fracture, clavicular fracture, 5-minute Apgar score <7) and documented management of shoulder dystocia (resolution manoeuvres performed, traction applied, head-to-body delivery interval).
  
  
  RESULTS
  Compliance with national guidance improved with continued training. At least one recognised resolution manoeuvre was used in 99.8% (561/562) of cases of shoulder dystocia in the late training period, demonstrating a continued improvement from 46.3% (150/324, P < 0.001) pre-training, and 92% (241/262, P < 0.001) in the early training period. In parallel there was reduction in the brachial plexus injury at birth (24/324 [7.4%, P < 0.01], pre-training, 6/262 [2.3%] early training, and 7/562 [1.3%] late training.
  
  
  CONCLUSIONS
  There are significant benefits to long-term, embedded training programmes with improvements in both management and outcomes. A decade after the introduction of training there were no cases of brachial plexus injury lasting over 12 months in 562 cases of shoulder dystocia.
authors: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors: J F
authors: JF
authors: Crofts
authors: School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol, UK.
authors: E
authors: E
authors: Lenguerrand
authors: North Bristol NHS Trust, Southmead Hospital, Bristol, UK.
authors: G L
authors: GL
authors: Bentham
authors: North Bristol NHS Trust, Southmead Hospital, Bristol, UK.
authors: S
authors: S
authors: Tawfik
authors: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors: H A
authors: HA
authors: Claireaux
authors: School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol, UK.
authors: D
authors: D
authors: Odd
authors: Taunton and Somerset NHS Trust, Taunton, UK.
authors: R
authors: R
authors: Fox
authors: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors: T J
authors: TJ
authors: Draycott
mesh_terms: D000328:Adult; D001720:Birth Injuries / Q000517:prevention & control*; D001917:Brachial Plexus / Q000293:injuries; D036861:Delivery, Obstetric / Q000193:education* / Q000379:methods; D004420:Dystocia / Q000517:prevention & control*; D004502:Education, Medical, Continuing; D004635:Emergency Medicine / Q000193:education*; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007231:Infant, Newborn; D065186:Interrupted Time Series Analysis; D009774:Obstetrics / Q000193:education*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D000070599:Shoulder Injuries; D006113:United Kingdom
keywords: Brachial plexus injury; shoulder dystocia; simulation; training