ATLANTA – Implementation of evidence-based practice bundles was associated with significant reductions in shoulder dystocia, brachial plexus injury, and operative vaginal delivery in a large multicenter hospital system.
From the 18 months prior to implementation of the bundles – which included a planned vaginal delivery tool to assess for shoulder dystocia risk – to the 36 months after implementation, the rate of shoulder dystocia decreased from 1.7 to 1.4 per 100 births, Dr. Laura Sienas reported at the annual Pregnancy Meeting sponsored by the Society for Maternal-Fetal Medicine.
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“This is a 17.6% reduction in the rate of shoulder dystocia. There was a statistically significant association with increasing bundle compliance of both bundles with a decrease in shoulder dystocia,” said Dr. Sienas, a 3rd-year resident at the University of California, Davis.
Additionally, the rate of brachial plexus injury decreased significantly from 2.1 to 1.5 per 1,000 births (a 29% reduction), and the rate of operative vaginal deliveries also decreased significantly, from 6.1 to 5.0 per 100 births (an 18% reduction).
At the same time, there was no significant change in the primary and total Cesarean section rates: 16.5 per 100 births and 30.1 per 100 births, respectively, she noted.
Key elements of the evidence-based practice bundles included an admission risk assessment, and a review and timeout prior to operative vaginal delivery. Low-fidelity shoulder dystocia drills were also introduced for nurses and physicians. While the drills improved teamwork and communication, they did not result in decreased brachial plexus injury rates, Dr. Sienas noted.
Future research should consider whether high-fidelity drills would lower the rate of brachial plexus injury, she added.
Data for this study was collected from 29 maternal centers, with size ranging from small and rural with fewer than 200 deliveries each year, to large urban hospitals with about 5,000 annual births. Baseline data included all singleton vertex births over 34 weeks’ gestation – about 169,000 total births. After all participating centers attained 90% compliance with the evidence-based practice bundles, about 103,000 deliveries occurred. Compliance with the bundles was scored as all or none.
The 29 hospitals in the health system where this study took place have average delivery volumes between 150 and 5,000 births per year, suggesting that the current findings would be applicable to nearly all delivery units in the United States, she said.
Dr. Sienas reported having no financial disclosures.