Does training in obstetric emergencies improve neonatal outcome?

Abstract

Objectives To determine whether the introduction of Obstetrics Emergency Training in line with the recommendations of the Clinical Negligence Scheme for Trusts (CNST) was associated with a reduction in perinatal asphyxia and neonatal hypoxic–ischaemic encephalopathy (HIE). Design A retrospective cohort observational study. Setting A tertiary referral maternity unit in a teaching hospital. Population Term, cephalic presenting, singleton infants born at Southmead Hospital between 1998 and 2003 were identified; those born by elective Caesarean sections were excluded. Method Five‐minute Apgar scores were reviewed. Infants that developed HIE were prospectively identified throughout this period. The study compared the period ‘pre‐training’ (1998–1999), with the period ‘post‐training’ (2001–2003). Main outcome measures Five‐minute Apgar scores and HIE. Results Infants (19,460) were included. Infants born with 5‐minute Apgar scores of ≤6 decreased from 86.6 to 44.6 per 10,000 births (P < 0.001) and those with HIE decreased from 27.3 to 13.6 per 10,000 births (P= 0.032) following the introduction of the training courses in 2000. Antepartum and intrapartum stillbirth at term rates remained unchanged, at about 15 and 4 per 10,000 births, respectively. Conclusion The introduction of obstetric emergencies training courses was associated with a significant reduction in low 5‐minute Apgar scores and HIE. This improvement has been sustained as the training has continued. This is the first time an educational intervention has been shown to be associated with a clinically important, and sustained, improvement in perinatal outcome.

Midwives’ adherence to guidelines on the management of birth asphyxia in Malawi

“…These results may be due to the fact that most of them had attended in-service courses in which birth asphyxia was taught. Training of health workers in obstetric emergencies improves neonatal care and outcome [9]. Thus the midwives were conversant with signs of birth asphyxia as also reported earlier at the same health facility [10] probably due to the coverage of the in-service curriculum on this aspect.…”

Myths and realities of training in obstetric emergencies

“…There are examples where litigation payments have been reduced in parallel to improvements in maternity outcomes: one UK group have identified improvements in perinatal outcomes after training [43] that have been associated with a 91% reduction in litigation payments.…”

“…Although there are expenses associated with training materials, training models and venues, the main costs of training are the release of staff to provide a faculty, and also staff to be trained. Few programmes have been costed formally, but in one UK training programme associated with improvements in outcomes [43], slightly more than 400 multiprofessional (midwife, anaesthetist, obstetrician and healthcare assistant) staff days were required to train a large UK maternity department.…”

Neurological damage arising from intrapartum hypoxia/acidosis

“…Furthermore, the acute nature of certain intrapartum events, as placental abruption, uterine rupture, cord prolapse, shoulder dystocia and retention of the aftercoming head, highlights the importance of adequate management, more than that of monitoring, in order to achieve a normal outcome. Regular CTG courses and simulation-based training of health-care teams in the management of these rare phenomena have been shown to reduce adverse obstetric outcomes, such as low Apgar scores and HIE [34], but their effect on perinatal mortality and CP are yet to be demonstrated.…”