Prevention of brachial plexus injury-12 years of shoulder dystocia training: an interrupted time-series study.

Autor: Crofts JF; School of Social and Community Medicine, University of Bristol, Bristol, UK., Lenguerrand E; School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol, UK., Bentham GL; North Bristol NHS Trust, Southmead Hospital, Bristol, UK., Tawfik S; North Bristol NHS Trust, Southmead Hospital, Bristol, UK., Claireaux HA; School of Social and Community Medicine, University of Bristol, Bristol, UK., Odd D; School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol, UK., Fox R; Taunton and Somerset NHS Trust, Taunton, UK., Draycott TJ; School of Social and Community Medicine, University of Bristol, Bristol, UK.
Jazyk: angličtina
Zdroj: BJOG : an international journal of obstetrics and gynaecology [BJOG] 2016 Jan; Vol. 123 (1), pp. 111-8. Date of Electronic Publication: 2015 Feb 17.
DOI: 10.1111/1471-0528.13302
Abstrakt: Objective: To investigate management and outcomes of incidences of shoulder dystocia in the 12 years following the introduction of an obstetric emergencies training programme.
Design: 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).
Setting: Southmead Hospital, Bristol, UK, with approximately 6000 births per annum.
Population: Infants and their mothers who experienced shoulder dystocia.
Method: 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.
Main Outcomes: 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.
(© 2015 Royal College of Obstetricians and Gynaecologists.)
Databáze: MEDLINE
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