Does training reduce the incidence of fetal injury in cases of shoulder dystocia?

Wilson, Louise V.; Ash, J; Crofts, Joanna F.; Sibanda, Thabani

doi:10.1097/01266021-200600130-00026

Cited by 5 publications

(5 citation statements)

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“…13 These results indicate that the improvements in performance seen during the posttraining evaluation of the simulation training sessions can translate into measurable improvement in clinical outcomes. This group has demonstrated a statistically significant reduction in clinical error related to shoulder dystocia management following introduction of simulation training, which has resulted in a 70% reduction in brachial plexus injuries.…”

Section: Review Of the Literaturementioning

confidence: 82%

“…Any training and/or drills must emphasize this point and providers must be cognizant that in certain cases this goal may not be achievable without fracture of the fetal arm or injury to the brachial plexus. 9,10,12,13 5 There is also evidence to indicate that simulation training can increase the likelihood that providers, both individually and as a team, will be able to successfully execute this systematic approach to shoulder dystocia.…”

Section: Introductionmentioning

confidence: 99%

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Shoulder Dystocia

Fahey

Mighty

2008

Journal of Perinatal &Amp; Neonatal Nursing

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Shoulder dystocia is an obstetric emergency that requires immediate recognition and a well-coordinated response. This response must include effective application of the maneuvers proven to relieve the impaction of the fetal shoulder and timely hand-off of the newborn to the neonatology team. The rare frequency of shoulder dystocia, coupled with patient safety concerns and the medico-legal environment, limits the opportunity of providers to learn and practice the management of shoulder dystocia. Training, especially simulation-based training, has been demonstrated to improve the management of shoulder dystocia. This article presents a review of the literature that supports simulation training for shoulder dystocia and provides guidance on creating and implementing shoulder dystocia training.

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Section: Review Of the Literaturementioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Shoulder Dystocia

Fahey

Mighty

2008

Journal of Perinatal &Amp; Neonatal Nursing

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“…This also falls in line with evidence in the literature to suggest that training providers with simulation can improve performance during actual deliveries, as well as decrease the incidence of fetal injury. 10 11 Hopefully, allowing delivering providers to perform simulated deliveries with accurate feedback on the amount of traction applied will help them realize when they may be applying excessive traction. 11 12 Additionally, the study supports the importance of remaining calm during obstetrical emergencies.…”

Section: Discussionmentioning

confidence: 99%

Visual Estimation of Force Applied During Simulated Deliveries Complicated by Shoulder Dystocia

Walters

Eubanks

Weissbrod

et al. 2018

AJP Rep

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Background Shoulder dystocia occurs when the fetal head delivers, but the shoulder is lodged behind the pubic symphysis. Training for these emergency deliveries is not optimized, and litigation can occur around a shoulder dystocia delivery. Objective Evaluate the ability of an outside observer to visually estimate the amount of traction applied to the fetal head during simulated deliveries complicated by shoulder dystocia. Study Design Simulated deliveries with an objective measurement of traction were randomly organized for estimation of traction applied. Videos show providers applying a “normal” (75 N) and “excessive” (150 N) amount of force in both a “calm” and “stressed” delivery. Results Fifty participants rated the amount of force applied. Observers estimated traction, on a scale from 1 to 5, higher in the 150-N deliveries as compared with 75-N deliveries (“calm” environment: 3.1 vs. 2.8, p < 0.001; and “stressed” environment: 3.2 vs. 2.8, p < 0.001). Only 15% of observers rated force “above average” or “excessive” in a “calm” environment, as opposed to 30% of observers in the “stressed” environment. Conclusion Observers are not able to determine when “excessive force” is used and are twice as likely to overestimate the force applied to a fetal head when an average amount of force is used and the delivery environment is stressful. Precis Observers are unable to determine when excessive traction is applied to the fetal head during simulated deliveries complicated by shoulder dystocia.

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“…19 In addition, two obstetric units in the UK have reported an improved clinical outcome following recorded SD after the introduction of training. 21,22 Case law suggests that less than adequate training may not be negligent provided an appropriate standard of care was provided. In Lobb v Hartlepool and East Durham NHS Trust (2002) Lloyd's Rep Med 442 a midwife did not apply suprapubic pressure due to lack of training, but this was not held causative of injury but did reflect poor practice.…”

Section: Shoulder Dystocia/no Shoulder Dystociamentioning

confidence: 98%

“…In addition, two obstetric units in the UK have reported an improved clinical outcome following recorded SD after the introduction of training. 21,22…”

Section: Justificationmentioning

confidence: 99%

A template for reviewing the strength of evidence for obstetric brachial plexus injury in clinical negligence claims

Sanders¹,

Crofts²,

Lloyd³

2008

Clinical Risk

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Obstetric brachial plexus injury (OBPI) is uncommon but accounts for a significant proportion of obstetric clinical negligence claims. There is debate in the medical literature and in legal proceedings regarding the causation of OBPI, particularly whether OBPI is caused by the accoucheur applying excessive traction or simply through the forces of labour itself.This paper reviews the medical literature and legal case law surrounding OBPI and presents a template for reviewing the strength of evidence for OBPI in clinical negligence claims. The template contains factors more likely to be present if the OBPI was caused by the maternal forces of labour 'propulsion injury' (injury to the posterior arm, no documented evidence of shoulder dystocia, up-todate training, appropriate shoulder dystocia management, no evidence of excessive traction, correct number of birth attendants, precipitous second stage, temporary injury) and factors more likely if the injury is iatrogenic (injury to the anterior arm, shoulder dystocia, no recent training, incorrect shoulder dystocia resolution manoeuvres used, evidence of excessive traction, insufficient birth attendants, fundal pressure, permanent injury). Each factor does not, in itself, establish causation, but the template may provide a useful aid to legal teams reviewing medical notes.

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Does training reduce the incidence of fetal injury in cases of shoulder dystocia?

Cited by 5 publications

References 0 publications

Shoulder Dystocia

Shoulder Dystocia

Visual Estimation of Force Applied During Simulated Deliveries Complicated by Shoulder Dystocia

A template for reviewing the strength of evidence for obstetric brachial plexus injury in clinical negligence claims

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