Thabani Sibanda

Improving neonatal outcome through practical shoulder dystocia training

OBJECTIVE: To compare the management of and neonatal injury associated with shoulder dystocia before and after introduction of mandatory shoulder dystocia simulation training. METHODS: This was a retrospective, observational study comparing the management and neonatal outcome of births complicated by shoulder dystocia before (January 1996 to December 1999) and after (January 2001 to December 2004) the introduction of shoulder dystocia training at Southmead Hospital, Bristol, United Kingdom. The management of shoulder dystocia and associated neonatal injuries were compared pretraining and posttraining through a review of intrapartum and postpartum records of term, cephalic, singleton births in which difficulty with the shoulders was recorded during the two study periods. RESULTS: There were 15,908 and 13,117 eligible births pretraining and posttraining, respectively. The shoulder dystocia rates were similar: pretraining 324 (2.04%) and posttraining 262 (2.00%) (P=.813). After training was introduced, clinical management improved: McRoberts’ position, pretraining 95/324 (29.3%) to 229/262 (87.4%) posttraining (P<.001); suprapubic pressure 90/324 (27.8%) to 119/262 (45.4%) (P<.001); internal rotational maneuver 22/324 (6.8%) to 29/262 (11.1%) (P=.020); delivery of posterior arm 24/324 (7.4%) to 52/262 (19.8%) (P<.001); no recognized maneuvers performed 174/324 (50.9%) to 21/262 (8.0%) (P<.001); documented excessive traction 54/324 (16.7%) to 24/262 (9.2%) (P=.010). There was a significant reduction in neonatal injury at birth after shoulder dystocia: 30/324 (9.3%) to 6/262 (2.3%) (relative risk 0.25 [confidence interval 0.11–0.57]). CONCLUSION: The introduction of shoulder dystocia training for all maternity staff was associated with improved management and neonatal outcomes of births complicated by shoulder dystocia. LEVEL OF EVIDENCE: II

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).

A simple tool to measure patient perceptions of operative birth

Objective  To assess the feasibility and validity of a maternal satisfaction measurement tool, the SaFE study Patient Perception Score (PPS), after operative delivery.

Quality improvement demands quality measurement

Please cite this paper as: Draycott T, Sibanda T, Laxton C, Winter C, Mahmood T, Fox R. Quality improvement demands quality measurement. BJOG 2010;117:1571–1574.

Fetal monitoring in labor: Are accelerations good enough?

Objective. To investigate whether accelerations of the fetal heart rate in response to scalp stimulation (the scalp stimulation test) before fetal scalp blood sampling (FBS) are such a good predictor of fetal well-being as to render the FBS unnecessary. Methods. A retrospective observational study. Cardiotocograms (CTG) from 54 fetuses during labor in whom 70 FBS procedures were performed, were analysed by an investigator blinded to the outcome, to determine whether accelerations were present in response to fetal scalp stimulation during vaginal examination (VE) prior to the FBS. This was compared with the pH obtained at FBS in a 2×2 table. The primary outcome measure was the false negative rate of the scalp stimulation test. Results. There were accelerations at 48 VEs before FBS (n = 70). In five cases there was fetal acidosis (pH ⩽ 7.20). Three of these five fetuses had accelerations at VE, giving a false negative rate of 6.25%. Conclusion. These data do not support previous reports that accelerations in response to fetal scalp stimulation before FBS exclude fetal acidosis when the CTG is suspicious and FBS is otherwise indicated. A larger sample may help answer this question.

Quality improvement demands quality measurement: Obstetric quality improvement metrics

Please cite this paper as: Draycott T, Sibanda T, Laxton C, Winter C, Mahmood T, Fox R. Quality improvement demands quality measurement. BJOG 2010;117:1571–1574.