Visual Estimation of Force Applied During Simulated Deliveries Complicated by Shoulder Dystocia

Margaret Walters; Allison Eubanks; Elizabeth Weissbrod; John Fischer; Barton Staat; Shad Deering

doi:10.1055/s-0038-1673377

American Journal of Perinatology Reports, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · AJP Rep 2018; 08(04): e206-e211
DOI: 10.1055/s-0038-1673377

Case Report

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Visual Estimation of Force Applied During Simulated Deliveries Complicated by Shoulder Dystocia

Margaret Walters

¹Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland

,

Allison Eubanks

¹Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland

,

Elizabeth Weissbrod

²The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.; Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland

,

John Fischer

¹Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland

,

Barton Staat

¹Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland

,

Shad Deering

¹Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland

› Institutsangaben

Abstract

Background Shoulder dystocia occurs when the fetal head delivers, but the shoulder is lodged behind the pubic symphysis. Training for these emergency deliveries is not optimized, and litigation can occur around a shoulder dystocia delivery.

Objective Evaluate the ability of an outside observer to visually estimate the amount of traction applied to the fetal head during simulated deliveries complicated by shoulder dystocia.

Study Design Simulated deliveries with an objective measurement of traction were randomly organized for estimation of traction applied. Videos show providers applying a “normal” (75 N) and “excessive” (150 N) amount of force in both a “calm” and “stressed” delivery.

Results Fifty participants rated the amount of force applied. Observers estimated traction, on a scale from 1 to 5, higher in the 150-N deliveries as compared with 75-N deliveries (“calm” environment: 3.1 vs. 2.8, p < 0.001; and “stressed” environment: 3.2 vs. 2.8, p < 0.001). Only 15% of observers rated force “above average” or “excessive” in a “calm” environment, as opposed to 30% of observers in the “stressed” environment.

Conclusion Observers are not able to determine when “excessive force” is used and are twice as likely to overestimate the force applied to a fetal head when an average amount of force is used and the delivery environment is stressful.

Precis Observers are unable to determine when excessive traction is applied to the fetal head during simulated deliveries complicated by shoulder dystocia.

Keywords

shoulder dystocia - training - traction - fetal injury - simulation - legal

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Referenzen

References
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