The effect of a multidisciplinary obstetric emergency team training program, the In Time course, on diagnosis to delivery interval following umbilical cord prolapse – A retrospective cohort study

Copson, Sean; Calvert, Katrina; Raman, Puvaneswary; Nathan, Elizabeth; Epee, Mathias

doi:10.1111/ajo.12530

Cited by 22 publications

(23 citation statements)

References 16 publications

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“…The change in documented manoeuvres may simply reflect an improvement in documentation in the post‐training era. As has been previously noted, improvements in documentation are likely to demonstrate improved teamwork and communication, and are additionally likely to result in improvements in medico‐legal outcomes . As our health authority does not currently link insurance payments to demonstrated improvements in documentation, this benefit remains under‐recognised.…”

Section: Discussionmentioning

confidence: 98%

“…The In Time course is a one‐day case‐based simulation training course focused on obstetric emergencies. It is designed to improve multi‐disciplinary teamwork . There is a strong emphasis on situational awareness, communication, knowledge, practical skills and manoeuvres in the context of managing obstetric emergencies.…”

Section: Methodsmentioning

confidence: 99%

“…The In Time obstetric simulation course, is a case‐based simulation training course designed to improve essential teamwork aspects of communication, leadership and situational awareness while consolidating knowledge and skills in the management of medical emergencies, including vaginal breech birth. Data from the In Time course on the management of cord prolapse have previously shown an improvement in teamwork post‐training implementation …”

Section: Introductionmentioning

confidence: 99%

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A retrospective cohort study of the impact of In Time obstetric simulation training on management of vaginal breech deliveries

Hardy

Garratt

Crossley

et al. 2020

Aust NZ J Obst Gynaeco

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Background: Following the Term Breech Trial, vaginal breech deliveries are rarely undertaken in Australia. Some women choose to have a breech delivery following counselling, while others will present in labour with an undiagnosed breech. Clinicians need to be skilled in vaginal breech delivery despite this being a rare clinical situation. Simulation training provides a means by which uncommon clinical situations can be practised. Aim: This study aims to determine if the introduction of a simulation-based training course is associated with an improvement in the management of vaginal breech delivery and neonatal outcomes. Methods: Cases of term vaginal breech delivery five years prior to introduction of In Time training (2001-2005) and five years after In Time training (2007-2011) were identified in a tertiary obstetric hospital (King Edward Memorial Hospital, Perth). There were 136 women identified in the pre-training (2001-2005, n = 56) and post-training (2007-2011, n = 80) groups. Case note review was undertaken to gather information. Results: Apgar scores of <7 at five minutes were higher in the post-training cohort (8.8% vs 0%, P = 0.041). Arterial and venous pH readings were similar between cohorts, with a non-significant trend toward improvement in the post-training cohort. Special care nursery admissions and length of hospital stay were unchanged. The primary accoucheur was more likely to be a consultant (35.0% vs 16.4%) in the post-training cohort. Appropriate manoeuvres were more likely to be used in the post-training cohort (52.5% vs 44.6%). Conclusions: Obstetric In Time simulation training improved seniority of accoucheur and documented appropriate manoeuvres in the management of term vaginal breech delivery.

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Section: Discussionmentioning

confidence: 98%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A retrospective cohort study of the impact of In Time obstetric simulation training on management of vaginal breech deliveries

Hardy

Garratt

Crossley

et al. 2020

Aust NZ J Obst Gynaeco

Self Cite

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“…9 However, such high perinatal mortality rates may be related to a prolonged period of fetal hypoxia before the patients were transferred to the hospitals for decision of delivery, and hence their result may not be applicable to developed countries. 1,4,7 Faiz et al demonstrated a contradictory result of improved Apgar score at 5 minutes when decision-to-delivery interval was longer than 20 minutes. 16 This paradoxical phenomenon was also demonstrated in Group 2, and likely resulted from a selection bias, in which the severe cases with poorer outcome were delivered urgently, whereas mild cases with good outcome tended to be delivered less urgently.…”

Section: Discussionmentioning

confidence: 99%

Bradycardia‐to‐delivery interval and fetal outcomes in umbilical cord prolapse

Wong

Tse

Lai

et al. 2020

Acta Obstet Gynecol Scand

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Introduction Umbilical cord prolapse is a major obstetric emergency associated with significant perinatal complications. However, there is no consensus on the optimal decision‐to‐delivery interval, as many previous studies have shown poor correlation between the interval and umbilical cord arterial blood gas or perinatal outcomes. We aim to investigate whether bradycardia‐to‐delivery or decision‐to‐delivery interval was related to poor cord arterial pH or adverse perinatal outcome in umbilical cord prolapse. Material and methods This was a retrospective study conducted at a university tertiary obstetric unit in Hong Kong. All women with singleton pregnancy complicated by cord prolapse during labor between 1995 and 2018 were included. Women were categorized into three groups. Group 1: persistent bradycardia; Group 2: any type of decelerations without bradycardia; and Group 3: normal fetal heart rate. The main outcome was cord arterial blood gas results of the newborns in different groups. Maternal demographic data and perinatal outcomes were reviewed. Correlation analysis between cord arterial blood gas result and time intervals including bradycardia‐to‐delivery, deceleration‐to‐delivery, and decision‐to‐delivery were performed for the different groups with Spearman test. Results There were 34, 30, and 50 women in Groups 1, 2, and 3, respectively. Cord arterial pH and base excess did not correlate with decision‐to‐delivery interval in any of the groups, but they were inversely correlated with bradycardia‐to‐delivery interval in Group 1 (Spearman’s ρ = −.349; P = .043 and Spearman's ρ = −.558; P = .001, respectively). The cord arterial pH drops at 0.009 per minute with bradycardia‐to‐delivery interval in Group 1 (95% CI 0.0180‐0.0003). The risk of significant acidosis (pH < 7) was 80% when bradycardia‐to‐delivery interval was >20 minutes, and 17.2% when the interval was <20 minutes. Conclusions There is significant correlation between bradycardia‐to‐delivery interval and cord arterial pH in umbilical cord prolapse with fetal bradycardia but not in cases with decelerations or normal heart rate. The drop of cord arterial pH is rapid and urgent delivery is essential in such situations.

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“… 31 However, Copson et al found non-significant improvements in all aspects of management apart from an increase in the number of babies with Apgar scores <7 at 5 minutes, and explained this by the high standard care prior to training. 32 In their case, Copson et al concluded that simulation training would maintain the high standard of care in their units.…”

Section: Simulation Training For Umbilical Cord Prolapsementioning

confidence: 99%

Optimal management of umbilical cord prolapse

Ali¹,

Hamdy²

2018

IJWH

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Umbilical cord prolapse (UCP) is an uncommon obstetric emergency that can have significant neonatal morbidity and/or mortality. It is diagnosed by seeing/palpating the prolapsed cord outside or within the vagina in addition to abnormal fetal heart rate patterns. Women at higher risk of UCP include multiparas with malpresentation. Other risk factors include polyhydramnios and multiple pregnancies. Iatrogenic UCP (up to 50% of cases) can occur in procedures such as amniotomy, fetal blood sampling, and insertion of a cervical ripening balloon. The perinatal outcome largely depends on the location where the prolapse occurred and the gestational age/birthweight of the fetus. When UCP is diagnosed, delivery should be expedited. Usually, cesarean section is the delivery mode of choice, but vaginal/instrumental delivery could be tried if deemed quicker, particularly in the second stage of labor. Diagnosis-to-delivery interval should ideally be less than 30 minutes; however, if it is expected to be lengthy, measures to relieve cord compression should be attempted. Manual elevation of the presenting part and Vago’s method (bladder filling) are the most commonly used maneuvers. Care should be given not to cause cord spasm with excessive manipulation. Simulation training has been shown to improve/maintain all aspects of management and documentation. Prompt diagnosis and interventions and the positive impact of neonatal management have significantly improved the neonatal outcome.

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The effect of a multidisciplinary obstetric emergency team training program, the In Time course, on diagnosis to delivery interval following umbilical cord prolapse – A retrospective cohort study

Cited by 22 publications

References 16 publications

A retrospective cohort study of the impact of In Time obstetric simulation training on management of vaginal breech deliveries

A retrospective cohort study of the impact of In Time obstetric simulation training on management of vaginal breech deliveries

Bradycardia‐to‐delivery interval and fetal outcomes in umbilical cord prolapse

Optimal management of umbilical cord prolapse

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