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Simulation in shoulder dystocia: does it change outcomes?

Tana Kim1,2, Rachel I Vogel2, Kamalini Das1,2

  • 1Department of Obstetrics and Gynecology, Regions Hospital, St Paul, Minnesota, USA.

BMJ Simulation & Technology Enhanced Learning
|May 6, 2022
PubMed
Summary

Shoulder dystocia simulation training doubled event frequency but did not improve maternal or neonatal outcomes. Increased provider awareness may be a benefit, despite rare occurrences.

Keywords:
mannequinmaternal outcomesneonatal outcomesshoulder dystociasimulation training

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Area of Science:

  • Obstetrics and Gynecology
  • Medical Simulation
  • Neonatal Outcomes

Background:

  • Shoulder dystocia is a critical obstetric emergency requiring prompt management to minimize neonatal harm.
  • Effective provider response is crucial for improving outcomes in shoulder dystocia cases.

Purpose of the Study:

  • To evaluate the impact of mandatory shoulder dystocia simulation training on maternal and neonatal outcomes.
  • To determine if simulation-based education enhances clinical performance during shoulder dystocia events.

Main Methods:

  • Retrospective cohort study comparing outcomes before and after simulation training implementation.
  • Statistical analysis included chi-squared tests, Fisher's exact tests, and logistic regression.
  • Data collected from 8,930 vaginal deliveries over a 6-year period.

Main Results:

  • The frequency of shoulder dystocia approximately doubled after training (1.9% vs 3.8%).
  • No statistically significant differences were observed in neonatal complications like brachial plexus injury or fractures.
  • Maternal outcomes, including episiotomy, postpartum hemorrhage, and severe perineal lacerations, also showed no significant change.

Conclusions:

  • Shoulder dystocia simulation training was associated with a higher reported incidence of the event.
  • The training did not lead to significant improvements in neonatal or maternal outcomes.
  • Simulation may enhance provider awareness and intervention for rare events like shoulder dystocia, even without direct outcome improvement.