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Objective  To determine whether the introduction of multi‐professional simulation training was associated with improvements in the management of cord prolapse, in particular, the diagnosis–delivery interval (DDI). Design  Retrospective cohort study. Setting  Large tertiary maternity unit within a University Hospital in the United Kingdom. Sample  All cases of cord prolapse with informative case record: 34 pre‐training, 28 post‐training. Methods  Review of hospital notes and software system entries; comparison of quality of management for umbilical cord prolapse pre‐training (1993–99) and post‐training (2001–07). Main outcome measures  Diagnosis–delivery interval; proportion of caesarean section (CS) in whom actions were taken to reduce cord compression; type of anaesthesia for CS births; rate of low (<7) 5‐minute Apgar scores; rate of admission to neonatal intensive care unit (NICU) (if birthweight >2500 g). Results  After training, there was a statistically significant reduction in median DDI from 25 to 14.5 minutes (P < 0.001). Post‐training, there was also a statistically significant increase in the proportion of CS where recommended actions had been performed (from 34.78 to 82.35%, P = 0.003). There was a nonsignificant increase in the use of spinal anaesthesia for CS, from 8.70 to 17.65%, and a nonsignificant reduction in the rate of low Apgar scores from 6.45 to 0% and in the rate of admission to NICU from 38.46 to 22.22%. Conclusions  The introduction of annual training, in accordance with national recommendations, was associated with improved management of cord prolapse. Future studies could assess whether this improved management translates into better outcomes for babies and their mothers.

Tubal assessment is an integral part of female fertility evaluation. While diagnostic laparoscopy is gold standard, it is not suitable to be used as a screening test. Hysterosalpingogram (HSG) has been advocated as first-line investigation historically. With advances in diagnostics, more tests are available, such as hysterosalpingo contrast sonography (HyCoSy) and Chlamydia antibody titre (CAT) are available. The CAT test is much cheaper, less invasive and can be performed at any time during the cycle. The CAT test can also be used as a means of identifying which patients need further evaluation. HyCoSy has same diagnostic accuracy as HSG, without exposing women to radiation. We argue that HSG is out of date and has no place in a modern infertility evaluation. We also suggest a pathway (based on history, clinical and ultrasound evaluation) for investigations to screen for and diagnose tubal pathology.

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