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Obstetrics & Gynecology 2008;112:906-912
© 2008 by The American College of Obstetricians and Gynecologists
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CURRENT COMMENTARIES

Observations From 450 Shoulder Dystocia Simulations

Lessons for Skills Training

Joanna F. Crofts, BM, BS1, Robert Fox, MB2, Denise Ellis, RM3, Catherine Winter, RM3, Kim Hinshaw, RM4 and Timothy J. Draycott, MD3

From the Departments of Obstetrics and Gynaecology, 1Musgrove Park Hospital, Taunton, 2Taunton and Somerset NHS Trust, Musgrove Park Hospital, Taunton, 3North Bristol NHS Trust, Southmead Hospital, Bristol, and 4Sunderland Royal Hospital, Sunderland, United Kingdom.

Poor neonatal outcomes after shoulder dystocia have been associated with inappropriate management. Until there are significant developments in the prediction and subsequent prevention of shoulder dystocia, improving shoulder dystocia management through practical training may be the most effective method of reducing the associated morbidity and mortality. Four hundred fifty simulated shoulder dystocia scenarios, managed by 95 midwives and 45 doctors from six U.K. hospitals during the course of 1 year, were video recorded during a study of obstetric emergency training. Analysis of recorded data revealed that, before training, 57% were unable to deliver the baby, almost two thirds failed to call for pediatric support, and 1 in 27 used fundal pressure. Recurring difficulties in management were observed: poor communication, inability to gain internal access, confusion over internal maneuvers, and the application of excessive traction. Significant improvements in management were observed after training and persisted up to 1 year after training. The lessons learned from this study can inform and improve future training and management. This article describes difficulties encountered by the participants and discusses how training may be focused to address these problems.




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A. J. Satin
Perfecting Practice
Obstet. Gynecol., October 1, 2008; 112(4): 746 - 747.
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