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Simulation in shoulder dystocia: does it change outcomes?

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  • Published on:
    Shoulder Dystocia Simulation Can Change Outcomes
    • Edith D, Gurewitsch Allen, Professor and Executive Vice Chair, Obstetrics & Gynecology and Women's Health Einstein School of Medicine, Montefiore Hospital
    • Other Contributors:
      • Robert H Allen, Assistant Research Professor, Dept of Obstetrics & Gynecology and Women's Health

    We congratulate Kim et al on developing a shoulder dystocia training program that included video instruction, a didactic portion and a simulation training session including force measurement, followed by a study aimed at evaluating the impact of the training on actual clinical outcomes.1 Their observed two-fold increase in shoulder dystocia incidence is consistent with some other studies,2, 3 and more in line with prospective clinical studies that report an incidence of ~ 4% among term vaginal deliveries.4, 5 It further suggests improved recognition of shoulder impaction in the final stages of delivery in the clinical setting following simulation-based training.

    Ultimately, the patient safety goal of shoulder dystocia simulation training for should be the reduction in shoulder dystocia-associated brachial plexus injuries. We would be interested to learn if there was a higher correlation between brachial plexus injuries and shoulder dystocia after training than before.

    Compared to other force training studies, Kim et al did not find a similar decrease in brachial plexus injuries.6-8 We offer a hypothesis as to why that might be.

    We believe that demonstrating what 100 N feels during simulation, even with admonishing the trainee not to use that much traction, is not effective at reducing injury. One reason is that memory of that much traction once experienced is short-lived, and clinicians tend to underestimate the traction they apply during a difficu...

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    Conflict of Interest:
    None declared.