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Impact of simulation training on decision to delivery interval in cord prolapse


Background Umbilical cord prolapse is a rare obstetric emergency requiring rapid coordination of a multidisciplinary team to effect urgent delivery. The decision to delivery interval (DDI) is a marker of quality of teamwork. Multidisciplinary team simulation-based training can be used to improve clinical and teamwork performance.

Aim To assess the DDI for cord prolapse before and after the introduction of simulation-based training at a quaternary maternity unit in Australia.

Method A retrospective, observational cohort study comparing the DDI before and after the introduction of simulation-based training activities. The general linear model was used to estimate the association between DDI and simulation training while adjusting for potential confounders including model of care (public or private) and time of birth (regular or after hours).

Results After the introduction of simulation training, mean DDI decreased by 4.1 min (difference −4.1, 95% CI −6.2 to −1.9), after adjustment for confounding factors. Despite this, there was no difference in selected neonatal outcomes including Apgar score at 5 min and arterial cord pH.

Conclusions The introduction of simulation-based training was associated with a decrease in the DDI in the setting of cord prolapse.

  • obstetric emergencies
  • simulation-based training
  • teamwork training

Data availability statement

Data are available on reasonable request. Deidentified individual participant data that underlie the results reported in this article will be available for up to 3 years after publication. Data will be shared with investigators who propose use of the data under a methodologically sound proposal. Proposals should be sent to To gain access, data requestors will be required to sign a data access agreement.

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