Objective Little is known about how teams’ non‐technical performance influences clinical performance in obstetric emergencies such as postpartum haemorrhage. Design Video review – observational study. Setting A university hospital (5000 deliveries) and a regional hospital (2000 deliveries) in Denmark. Population Obstetric teams managing real‐life postpartum haemorrhage. Methods We systematically assessed 99 video recordings of obstetric teams managing real‐life major postpartum haemorrhage. Exposure was the non‐technical score (AOTP); outcomes were the clinical performance score (TeamOBS) and the delayed transfer to the operating theatre (defined as blood loss >1500 ml in the delivery room). Results Teams with an excellent non‐technical score performed significantly better than teams with a poor non‐technical score: 83.7 versus 0.3% chance of a high clinical performance score (P < 0.001), 0.2 versus 80% risk of a low clinical performance score (P < 0.001), and 3.5 versus 31.7% risk of delayed transfer to the operating theatre (P = 0.008). The results remained robust when adjusting for potential confounders such as bleeding velocity, aetiology, time of day, team size, and hospital. The specific non‐technical skills associated with high clinical performance were vigilance, role assignment, problem‐solving, management of disruptive behavior, and leadership. Communication with the patient and closing the loop were of minor importance. All performance assessments showed good reliability: the intraclass correlation was 0.97 (95% CI 0.96–0.98) for the non‐technical score and 0.84 (95% CI 0.76–0.89) for the clinical performance score. Conclusion Video review offers a new method and new perspectives for research in obstetric teams to identify how teams become effective and safe; the skills identified in this study can be included in future obstetric training programmes. Tweetable abstract Non‐technical performance is important for teams managing postpartum haemorrhage; video review of 99 obstetric teams.

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The TeamOBS-PPH tool appears to be valid and reliable for assessing clinical performance in real-life and simulated settings. The tool will be shared as the free TeamOBS App.

Introduction Little is known about the optimal simulation‐based team training in obstetric emergencies. We aimed to review how simulation‐based team training affects patient outcomes in obstetric emergencies. Material and methods Search Strategy: MEDLINE, Embase, Cochrane Library, and Cochrane Central Register of Controlled Trials were searched up to and including May 15, 2021. Selection criteria: randomized controlled trials (RCTs) and cohort studies on obstetric teams in high‐resource settings comparing the effect of simulation‐based obstetric emergency team training with no training on the risk of Apgar scores less than 7 at 5 min, neonatal hypoxic ischemic encephalopathy, severe postpartum hemorrhage, blood transfusion of four or more units, and delay of emergency cesarean section by more than 30 min. Data collection and analysis: The included studies were assessed using PRISMA, EPCO, and GRADE. Results We found 21 studies, four RCTs and 17 cohort studies, evaluating patient outcomes after obstetric team training compared with no training. Annual obstetric emergency team training may reduce brachial plexus injury (six cohort studies: odds ratio [OR] 0.47, 95% CI 0.33–0.68; one RCT: OR 1.30, 95 CI% 0.39–4.33, low certainty evidence) and suggest a positive effect; but it was not significant on Apgar score below 7 at 5 min (three cohort studies: OR 0.77, 95% CI 0.51–1.19; two RCT: OR 0.87, 95% CI 0.72–1.05, moderate certainty evidence). The effect was unclear for hypoxic ischemic encephalopathy, umbilical prolapse, decision to birth interval in emergency cesarean section, and for severe postpartum hemorrhage. Studies with in situ multi‐professional simulation‐based training demonstrated the best effect. Conclusions Emerging evidence suggests an effect of obstetric team training on obstetric outcomes, but conflicting results call for controlled trials targeted to identify the optimal methodology for effective team training.