Incidence of obstetric brachial plexus palsy after a training program in shoulder dystocia.

INTRODUCTION: Shoulder dystocia is a nonpreventable obstetric emergency that causes severe complications, such as obstetric brachial plexus palsy. The objective of the study was to determine the incidence of obstetric brachial plexus palsy and other neonatal complications associated with shoulder dystocia in deliveries managed in a university hospital after the implementation of a simulation-based training that was offered to all the labour and delivery staff on a voluntary basis. MATERIAL AND METHODS: Retrospective observational study including all cases of shoulder dystocia and associated complications (mainly obstetric brachial plexus palsy) documented between January 2017 and December 2020, after the implementation of the training. In addition, we collected retrospective data on cases of obstetric brachial plexus palsy that developed in the hospital before the training (2008-2016). RESULTS: In the 2017-2020 period, in the total of 125 cases of shoulder dystocia (amounting to 1.38% of vaginal deliveries), there were 14 cases of obstetric brachial plexus palsy (11.2% of the cases of shoulder dystocia), 7 clavicle fractures and 1 humerus fracture; none of the cases of obstetric brachial plexus palsy was permanent or required treatment or rehabilitation past six months. In the years preceding the training, there were 7 cases of obstetric brachial plexus palsy, 2 permanent and 5 temporary (3 of which required rehabilitation). CONCLUSION: These results reflect the importance of knowing the morbidity present in the labour and delivery ward and the potential benefit of simulation-based training programmes in the resolution of these obstetric complications.

[Knowledge assessment of shoulder dystocia management by Spanish professionals.] / Evaluación del conocimiento en la resolución de la distocia de hombros en profesionales españoles.

OBJECTIVE: Shoulder dystocia (SD) training is recommended by diverse international healthcare organizations; however, it is not so in Spain, and there is no specific programmes. The objective of the study was to evaluate the level of knowledge and attitudes towards resolving a SD among a large sample of spanish obstetricians and midwives. METHODS: A multi-professional team carried out simulation-based training courses. Descriptive observational study where mean, standard deviation, minimum and maximum or median and interquartile intervals according to the distribution will be used for continuous variables. For the discrete variables, the number and the corresponding percentages will be reported. RESULTS: Between December 2015 and 2019, the team carried out 17 editions of SD workshop and 904 active professionals were trained in labour wards in different parts of Spain. The results showed that 64.8% of the professionals had learned to solve shoulder dystocia through books and/or 58.4% theoretical classes. 60.4% (380) of the respondents had not received any type of training in simulation in obstetrics. 87.1% (415/476) of the students had not felt prepared to face a SD when they finished the residency At the time of answering this survey, 61.8% (358) did not feel prepared to solve a SD. CONCLUSIONS: Training in Shoulder Dystocia in Spain is mainly theoretical and a high number of professionals recognize that they are not sufficiently prepared to face it with guarantees.

OBJETIVO: El entrenamiento en distocia de hombros (DH) está recomendado por numerosas sociedades médicas internacionales y, sin embargo, en España, no existen programas específicos de entrenamiento. El objetivo de este estudio fue evaluar el nivel de conocimiento y habilidades prácticas para resolver una distocia de hombros de un amplio número de matronas y ginecólogos españoles que habían realizado un curso basado en simulación. METODOS: El equipo multiprofesional de simulación obstétrica realizo talleres basados en simulación para la resolución de la DH. Estudio descriptivo observacional donde para las variables continuas se utilizará media, desviación estándar, mínimo y máximo o mediana e intervalos intercuartiles de acuerdo con la distribución. Para las variables discretas se reportarán el número y los porcentajes correspondientes. RESULTADOS: Entre diciembre de 2015 y 2019, el equipo llevo a cabo 17 ediciones del taller de DH y formo a 904 profesionales de diferentes partes de España. Los resultados mostraron que Un 64,8% de los profesionales había aprendido a solucionar la distocia de hombros a través de libros y/o un 58,4% clases teóricas. El 60,4% (380) de los encuestados, no había recibido ningún tipo de formación en simulación en obstetricia. Un 87,1% (415/476) de los alumnos no se había sentido preparado para enfrentarse a una DH cuando terminó la residencia En el momento de contestar esta encuesta, un 61,8% (358) no se sentía preparado para resolver una DH. CONCLUSIONES: La formación en distocia de hombros en España es principalmente teórica y un alto numero de profesionales reconoce que no están suficientemente preparados para afrontarla con garantías.