Does Simulation Training for Shoulder Dystocia Reduce Brachial Plexus Birth Injury?
BACKGROUND AND PURPOSE:
Kaijomaa et al. (BJOG, 2022) assessed the impact of shoulder dystocia (SD) simulation training on management and the incidence of permanent brachial plexus birth injury (BPBI)
Retrospective observational study
Helsinki Women’s Hospital
Deliveries with SD
Pre SD simulation training implementation: 2010 to 2014
Post training implementation: 2015 to 2019
3 hour simulation-based training sessions
Conducted at a simulation center
Each group consisted of 4 to 6 midwives, 1 resident and 1 senior doctor
Following McRoberts and suprapubic pressure, no technique taught to be superior to another
The avoidance of harmful techniques (e.g., fundal pressure) was also taught
Incidence of permanent BPBI after the implementation of systematic simulation training
Changes in SD management
The incidence of major SD risk factors increased during the post-training period (P<0.001)
Induction of labor
The incidence of SD increased during the post-implementation period (P<0.001)
Number of children with permanent BPBI decreased after the implementation of simulation training (P<0.001)
Most significant change in the management of SD was increased incidence of successful delivery of posterior arm (P=0.04)
The years following implementation of SD simulation training were associated with more SD cases, but fewer children with BPBI, compared to the years prior to training implementation
The authors state
The annual training of all providers is difficult in our sizeable clinic with its continuous turnover of staff; however, the proportion of (at least once) trained providers has varied between 70 and 80%
We believe that this has been enough to improve the common knowledge of the SD management and teamwork in the clinic
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