Simulation models are widespread educational tools for training for rare clinical scenarios. This study compared maternal and neonatal outcomes before and after implementation of a shoulder dystocia simulation protocol.
Vaginal deliveries at a single institution from September 2008 to December 2014 were reviewed. Mandatory shoulder dystocia simulation training was implemented for obstetric providers at the end of 2009. Incidence of shoulder dystocia and delivery outcome was compared pre and post simulation. Chi-squared and Fisher Exact tests along with multivariate logistic regression models were conducted to adjust for potential confounding.
9401 vaginal deliveries were identified. 304 deliveries were associated with a shoulder dystocia (3.2%). The rate of any shoulder dystocia was approximately two times higher post-simulation (1.8% versus 3.7%; P<.0001). This remained significant after adjustment for maternal age, race, diabetes status, body mass index, Pitocin, delivery method, sex and birth weight (OR 2.19, 95% CI [1.45–3.12]; P=.0002). The rate of severe shoulder dystocia was higher post intervention as well (0.6% versus 1.4%; P=.005). There was no decrease from pre to post simulation in birth injury (7.5% versus 11.4%; P=.59), postpartum hemorrhage (10.0% versus 12.9%; P=.80), third or fourth degree lacerations (10.0% versus 6.8%; P=.51), or episiotomies (5.0% versus 5.3%; P=1.00).
Simulation training was associated with increased identification of shoulder dystocia events without decrease in adverse maternal or neonatal outcomes. Antepartum and intrapartum risk categorization, counseling, and individualized delivery planning must be considered as provider training alone does not impact adverse maternal and neonatal outcomes.
University of Minnesota, Minneapolis, MN
Financial Disclosure: The authors did not report any potential conflicts of interest.