Management Of Shoulder Dystocia Research Articles

Improving Shoulder Dystocia Management and Outcomes With a Targeted Quality Assurance Program

(Abstracted from Am J Perinatol 2017;34:1088–1096) Simulation-based training has been shown by several investigators to help obstetric trainees in mastering shoulder dystocia management skills and in reducing rates of brachial plexus injury. However, the comparative effectiveness of specific simulation schemes is still debatable.

Effect of the use of a video tutorial in addition to simulation in learning the maneuvers for shoulder dystocia

The development of video tutorials is flourishing and may make it possible to maintain knowledge learned during instruction with simulation. The aim of this study was to assess the effect of adding a video tutorial to a lecture and simulation for learning the maneuvers and protocol for the management of shoulder dystocia. Student midwives and medical students attended a lecture class including instruction about maneuvers and a presentation of an algorithm for the management of shoulder dystocia. They were randomized into two groups. The video group was reminded every two weeks to watch a short tutorial. The control group was reminded to consult the slide show. At the end of two months, they were evaluated by graders. The practice, theory, and global scores of the students in the video group were significantly higher than those of the students in the control group (14.8 vs. 10.4; 5.6 vs. 3.4; and 9.3 vs. 7.0, P<0.001). The scores for the video group improved at the second simulation session, compared with the first (14.8 vs. 9.9; 5.6 vs. 2.9; and 9.3 vs. 7, P<0.001). The addition of a video tutorial improved learning compared to a standard lecture and simulation session alone.

Strategies to Improve Management of Shoulder Dystocia Under the AHRQ Safety Program for Perinatal Care

ObjectiveTo assess implementation of safety strategies to improve management of births complicated by shoulder dystocia in labor and delivery units. DesignMixed-methods implementation evaluation. Setting/Local ProblemLabor and delivery units (N = 18) in 10 states participating in the Safety Program for Perinatal Care (SPPC). Shoulder dystocia is unpredictable, requiring rapid and coordinated action. ParticipantsKey informants were labor and delivery unit staff who implemented SPPC safety strategies. Intervention/MeasurementsThe SPPC was implemented by using the TeamSTEPPS teamwork and communication framework and tools, applying safety science principles (standardization, independent checks, and learn from defects) to shoulder dystocia management, and establishing an in situ simulation program focused on shoulder dystocia to practice teamwork and communication skills. Unit staff received training, a toolkit, technical assistance, and unit-specific feedback reports. Quantitative data on unit-reported process improvement measures and qualitative data from staff interviews were used to understand changes in use of safety principles, teamwork/communication, and in situ simulation. ResultsUse of shoulder dystocia safety strategies improved on the units. Differences between baseline and follow-up (10 months) were as follows: in situ simulation (50% vs. 89%), teamwork and communication (67% vs. 94%), standardization (67% to 94%), learning from defects (67% vs. 89%), and independent checks (56% vs. 78%). Interview data showed reasons to address management of shoulder dystocia, various approaches to implement safety practices, and facilitators and barriers to implementation. ConclusionSuccessful management of shoulder dystocia requires a rapid, standardized, and coordinated response. The SPPC strategies to increase safety of shoulder dystocia management are scalable, replicable, and adaptable to unit needs and circumstances.

THE EFFECT OF USING VIDEO MEDIA IN SKILLLABORATORY FOR STUDENT’S KNOWLEDGE AND SKILL IN MANAGING SHOULDER DYSTOCIA ATUBUDIYAH INDONESIA UNIVERSITY

Shoulder dystocia is one of the most problematic obstetric causes which is strongly associated with fetal morbidity and mortality. Health providers should be prepared to deal with this obstetrics emergency. Qualified midwives are generated by educational institutions which attach to science development, information technology and regulation. One of them is skill laboratory during education with video. Laboratory activities using methods and appropriate learning media and varied will lead the students to the formation of skills and creativity in receiving knowledge.The research method was a quasiexperimental design with control group design. Subjects were students of fourth semester at Diploma III of Midwifery of U'BudiyahIndonesia University. Total sample was 32 people. Total population was used as technique of sampling. The analysis used univariate, bivariate analysis with the Mann Whitney test and t test and multifariate analysis using manova test with a significance level of 0.05.The results showed an increase of knowledge of the treatment group from 76,7 to 86,7, and in the control group 66,7 to 80, statistically significantly different (p=0.001). Increase of skill of the treatment group from 50,8 to 90, and in the control group 48,6 to 75,5, statistically significantly different (p&lt;0.001). Media video effect simultaneously on the knowledge and skills in the treatment groups (p &lt;0.001). The percentage increase of 89.16% in the treatment group and the control group 62.44%.The percentage increase of 89.16% in the treatment group and the control group 62.44%.Conclusion results of the research, knowledge and skills of student about shoulder dystocia are higher on the given media video group compared to the control group. Keywords: video media, knowledge, skills, managing shoulder dystocia.

Randomised controlled study to assess skill retention at 6 vs 12 months after simulation training in shoulder dystocia

IntroductionCurrent evidence suggests annual training in the management of shoulder dystocia is adequate. The aim of this trial is to test our hypothesis that skills start to decline at 6...

Improving Shoulder Dystocia Management and Outcomes with a Targeted Quality Assurance Program.

Background Several investigators have achieved remarkable success in transferring shoulder dystocia management skills mastered with simulation training to clinical practice. However, other investigators have not demonstrated similar benefits, raising questions about the comparative effectiveness of specific simulation schemes, instructional content, and additional quality assurance measures between successful and unsuccessful interventions. After our initial review revealed gaps in following shoulder dystocia management algorithms, documentation and timely follow-up of injured neonates, we developed and implemented five interventions, three educational and two systems-level, aimed at improving shoulder dystocia management. Objective To describe the clinical impact of a systematic program of quality improvement on outcomes of vaginal births complicated by shoulder dystocia. Setting An urban tertiary academic medical center that trains 36 obstetrics/gynecology residents (9 per year) and provides comprehensive obstetrical services for approximately 2,000 deliveries annually. Study Design We use SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence) to (1) describe our core instructional content and simulation-based practice, emphasizing specific proscriptive and prescriptive recommendations and their evidence basis, and (2) to report an interrupted time series assessment of the clinical impact of our systematic quality improvement program targeting shoulder dystocia-associated brachial plexus injury. Results Compared with baseline (June 1993 to December 2004), the incidence of shoulder dystocia among vaginally delivered infants with birth weight ≥ 2,500 g at Johns Hopkins Hospital (January 2014 to December 2015) increased from 2.6 to 4.6% (X 2 = 29.8; df = 1; p &lt; 0.0001); in addition, documentation improved, direct fetal manipulation increased, while use of episiotomy for the management of shoulder dystocia decreased. While preintervention only 65% of brachial plexus injury were associated with shoulder dystocia, 100% of neonatal brachial plexus injuries were associated with shoulder dystocia postintervention (80/122 [65%] vs. 7/7 [100%], X 2 = 3.66; df = 1; p = 0.055), a trend reflecting simultaneous increased recognition of impacted shoulders and improved overall management of shoulder dystocia. Most importantly, the incidence of brachial plexus injury among shoulder-dystocia-complicated vaginal deliveries has decreased from a baseline of 31.6 to 6.3% (X 2 = 27.9; df = 1; p &lt; 0.0001), and the absolute brachial plexus injury rate declined from 8.2 to 2.9 per 1,000 vaginal births ≥ 2,500 g, a reduction of 64.5% (X 2 = 7.3; df = 1; p = 0.007). Conclusion A systematic program of quality assurance with specific proscriptive and prescriptive instructional content and management recommendations is associated with improved recognition, management, and clinical outcomes of shoulder dystocia.

The comparison the effect of training by means of simulation and oral method on midwives' skill in management of shoulder dystocia.

INTRODUCTION:Shoulder dystocia is one of the obstetric emergencies that are accompanied to serious risks for mother and fetus. It necessitates making the method of training of shoulder dystocia management more efficient, i.e., better management and giving services with higher quality. Thus, this study was carried out to compare the impact of training by simulation and oral technique on the skill of the employed midwives in obstetric clinics at Mashhad city (Iran) in shoulder dystocia management during 2012.METHODS:The current research is a double-group clinical trial that was conducted on 51 members of the employed midwives in the obstetric clinic at Mashhad city in 2012. The questionnaire of personal specification and awareness about shoulder dystocia and practical examination (objective-structured clinical examination) were employed as tools for data collection. The learners were divided into two groups by randomized allocation. Training was done by the presentation of lecture in the oral content group and a short movie was displayed at the end of it. The shoulder dystocia management technique was simulated in another group and through role-playing of instructor application of moulage (station) training was conducted. The period of the training course (4 h) and content of the educational workshop was identical for both groups. The practical examination was held for the learners before and immediately after training course. The given data were analyzed by means of statistical descriptive tests including Mann–Whitney U-test and Wilcoxon test via SPSS software (version 16). The significance level was considered as (P < 0.05) in all cases.RESULTS:The total mean score was significantly increased for the variable of shoulder dystocia management skill after intervention in both groups (P < 0.0001). Similarly, the results of Mann–Whitney U-test statistical tests indicated that total mean score for the variable of shoulder dystocia management skill after the intervention was significantly greater in simulation group than in an oral group (P = 0.040).CONCLUSION:Training in simulated delivery room by means of role-playing is an efficient method for training shoulder dystocia management skill, so it is recommended to use this program in the training of this skill.

What's in a mnemonic?

The Chair of ALSO UK's Executive Board of Trustees reminds practioners of the organisation's position on best practice for learning—and applying—HELPERR to manage shoulder dystocia

Management of shoulder dystocia using the HELPERR mnemonic

Shoulder dystocia is a rare obstetric emergency which can be managed using the HELPERR mnemonic. Midwives should recognise the signs and understand the principles of managing shoulder dystocia. Step-by-step images to illustrate the HELPERR mnemonic can enhance knowledge and understanding of this logical sequence of actions.

Effect of High-fidelity Shoulder Dystocia Simulation on Emergency Obstetric Skills and Crew Resource Management Skills Among Residents

(Int J Gynaecol Obstet. 2016. pii: S0020-7292(16)30348–4) Shoulder dystocia is associated with a high incidence of neonatal morbidity and mortality. Effective management of this obstetric complication requires swift collaboration between the lead physician and obstetrics team. In the present study, the authors determineed the impact of high-fidelity simulation training on the ability of obstetrics and gynecology residents to effectively manage shoulder dystocia emergencies.

The comparison the effect of training by means of simulation and oral method on midwives' skill in management of shoulder dystocia

The comparison the effect of training by means of simulation and oral method on midwives' skill in management of shoulder dystocia

906: Targeted training effort improves shoulder dystocia management and outcomes

906: Targeted training effort improves shoulder dystocia management and outcomes

Team Training and Institutional Protocols to Prevent Shoulder Dystocia Complications.

Shoulder dystocia is an obstetrical emergency that may result in significant neonatal complications. It requires rapid recognition and a coordinated response. Standardization of care, teamwork and communication, and clinical simulation are the key components of patient safety programs in obstetrics. Simulation-based team training and institutional protocols for the management of shoulder dystocia are emerging as integral components of many labor and delivery safety initiatives because of their impact on technical skills and team performance.

An Update on the Acute Management of Shoulder Dystocia.

Shoulder dystocia continues to challenge obstetrical providers and therefore the management must evolve. The available literature demonstrates clear value in both simulation training and having a clear algorithmic approach. Similarly, the available literature suggests that delivery of the posterior arm should be prioritized. Several new techniques such as the Menticoglou maneuver, Gaskin's maneuver, and the posterior axilla sling traction technique offer obstetrical choices after more traditional techniques have failed.

Effect of Implementing a Standardized Shoulder Dystocia Documentation Form on Quality of Delivery Notes.

Complete and accurate documentation by the delivering provider in cases of shoulder dystocia is critical for providing clinical information and care to the patient and protecting providers from litigation risks. Standardized forms improve inclusion of certain data elements in the medical record, but the impact on subsequent narrative notes is unknown. We aimed to determine if implementation of a standardized shoulder dystocia documentation form improves obstetric provider written narrative delivery notes. In February 2005, our institution introduced a mandatory, standardized shoulder dystocia form containing 29 discrete data points relevant to shoulder dystocia documentation. We identified all deliveries complicated by shoulder dystocia from 1 year before and 4 years after implementation of this form and analyzed medical records for inclusion of delivery information in both the required form and the narrative delivery notes. We identified 52 cases before and 100 cases after implementation of the standardized form. Inclusion of elements from the form in narrative delivery notes increased significantly after implementation (P = 0.01). Elements present at higher rates included prepregnancy maternal weight (13% before vs 28% after, P = 0.043), total maternal weight gain (19% vs 36%, P = 0.03), estimated fetal weight (60% vs 77%, P = 0.03), duration of active labor (40% vs 65%, P < 0.01), duration of second stage (27% vs 52%, P < 0.01), and time of delivery from head to body (4% vs 30%, P < 0.01). Use of a mandatory shoulder dystocia documentation form is associated with significant improvement in the comprehensiveness of delivering provider narrative notes and may encourage more complete and accurate charting. Such improvements can allow for more complete and accurate explanation of events to patients and better demonstrate adherence to standards of care in the management of shoulder dystocia and may improve litigation defensibility.

Changing Labor and Delivery Practice: Focus on Achieving Practice and Documentation Standardization with the Goal of Improving Neonatal Outcomes.

To establish multifactorial shoulder dystocia response and management protocol to promote sustainable practice change. Primary data collection was conducted over 3years. Implementation of the protocol spanned 13months. Data collection occurred at five sites, which were chosen for their diversity in both patient mix and geographical location. Case study evaluation methodology was used to examine clinician engagement and protocol adoption. The training completion for all practice engagement team activities was collected by the site project manager and entered into a flat file. Data from the labor and delivery notes, medical records, and interviews with labor and delivery teams were gathered and analyzed by the senior investigator. In the first year, there was a threefold increase in shoulder dystocia reporting, which continued in years 2 and 3. In the first year, 96 percent of clinicians completed all training elements and in subsequent years, 98 percent completed the follow-up training. Overall teams reached a 99 percent adoption rate of the shoulder dystocia protocol. System and site management teams implemented a standardized shoulder dystocia protocol that fostered effective teamwork and obstetric team readiness for managing shoulder dystocia emergencies.

Effect of high-fidelity shoulder dystocia simulation on emergency obstetric skills and crew resource management skills among residents

ObjectiveTo determine the effect of a simulation training program for residents in obstetrics and gynecology in terms of technical and nontechnical skills for the management of shoulder dystocia. MethodsA prospective study was performed at a center in Italy in April–May 2015. Thirty-two obstetrics and gynecology residents were divided into two groups. Residents in the control group were immediately exposed to an emergency shoulder dystocia scenario, whereas those in the simulation group completed a 2-hour training session with the simulator before being exposed to the scenario. After 8weeks, the residents were again exposed to the shoulder dystocia scenario and reassessed. Participants were scored on their demonstration of technical and nontechnical skills. ResultsIn the first set of scenarios, the mean score was higher in the simulation group than the control group in terms of both technical skills (P=0.008) and nontechnical skills (P<0.001). This difference was retained after 8weeks. ConclusionHigh-fidelity simulation programs could be used for the training of residents in obstetrics and gynecology to diagnose and manage obstetric emergencies such as shoulder dystocia.

Effectiveness of Manikin Demonstration over Conventional Lectures for Teaching Shoulder Dystocia

Background: Shoulder dystocia management necessitates a sound knowledge in diagnosis and applications of appropriate maneuvers. Conventionally this topic is taught with lectures in our institution. Objectives: 1. To compare the effectiveness of manikin demonstration to didactic lecture in teaching shoulder dystocia to undergraduate students. 2. To assess the attitude of students regarding inclusion of demonstrations sessions with manikin to their teaching schedule. Methods: This comparative study was conducted on 60 students attending their 8 semester posting in OBG in Kannur Medical College. Students were divided in to two batches, one receiving a didactic lecture class and the other a manikin demonstration on shoulder dystocia, following which a posttest evaluation was carried out with MCQs. The next day students were crossed over and classes taken using the two methods following which feedback from students were obtained and analyzed. Results: The posttest scores revealed that the group taught by manikin demonstration scored better when compared to the batch taught by lecture which was statistically significant. Feedback analysis showed that all students found manikin demonstration a more interesting method and majority felt this was the better method and helped in understanding the maneuvers. Peer opinion was that though manikin demonstration was more interesting, theoretical aspects could be better covered by a lecture and hence should be used as a complementary method to lecture. Conclusion: Manikin demonstration was more effective in teaching shoulder dystocia when compared to conventional lectures and was also associated with better learner satisfaction.

Is fetal manipulation during shoulder dystocia management associated with severe maternal and neonatal morbidities?

There is a lack of data regarding maternal morbidity and neonatal hypoxia associated with shoulder dystocia (SD), particularly with respect to whether SD is managed with our without fetal manipulation (FM). Our main objective was to compare severe maternal and neonatal morbidities associated with SD according to FM execution. We conducted a retrospective study based on a medical record analysis that included all SD cases from 2007 to 2012. SD was considered when additional maneuvers were required to complete a delivery. Severe maternal morbidity was defined as the occurrence of an obstetric anal sphincter injury. Severe neonatal morbidity was defined as the occurrence of one of these complications: permanent brachial plexus palsy, arterial cord pH<7.1, Apgar score<7 at 5min. We compared severe maternal and neonatal morbidities in the FM and the no-FM group. We report an SD incidence of 2.4% (n=227) with 93.8% of patients treated without FM. We identified two cases of permanent brachial plexus palsy, fifteen cases of arterial cord pH<7.1 and six cases with an Apgar score<7 at 5min; all of them were from the no-FM group. There were more cases of OASI in the FM group (odd ratio=9.2 [1.32-50.71]). No statistical differences between these groups were observed with respect to severe neonatal morbidity. Severe neonatal morbidity does not appear to be associated with FM during SD management, but severe maternal morbidity is associated with FM execution.

Effectiveness of team training in managing shoulder dystocia: a retrospective study

Objectives: To evaluate the effectiveness of simulation team training for the management of shoulder dystocia. Primary outcome measures were the number of reported cases of shoulder dystocia, as well as fetal injury that occurred from it. Secondary outcome is documentation of manoeuvres used to alleviate shoulder dystocia.Methods: Retrospective cohort study in a teaching hospital in the Netherlands, in a 38 month period before and after implementation of team training.Results: We compared 3492 term vaginal cephalic deliveries with 3496 deliveries before and after team training. Incidence of shoulder dystocia increased from 51 to 90 cases (RR 1.8 (95% CI: 1.3–2.5)). Fetal injury occurred in 16 and eight cases, respectively (RR 0.50 (95% CI: 0.21–1.2)). Before team training started, the all-fours manoeuvre was never used, while after team training it was used in 41 of 90 cases (45%). Proper documentation of all manoeuvres used to alleviate shoulder dystocia significantly increased after team training (RR 1.6 (95% CI: 1.05–2.5)).Conclusions: Simulation team training increased the frequency of shoulder dystocia, facilitated implementation of the all-fours technique, improved documentation of delivery notes and may have a beneficial effect on the number of children injured due to shoulder dystocia.