ObjectiveTo investigate management and outcomes of incidences of shoulder dystocia in the 12years following the introduction of an obstetric emergencies training programme.DesignInterrupted time-series study comparing management and neonatal outcome of births complicated by shoulder dystocia over three 4-year periods: (i) Pre-training (1996-99), (ii) Early training (2001-04), and (iii) Late training (2009-12).SettingSouthmead Hospital, Bristol, UK, with approximately 6000 births per annum.PopulationInfants and their mothers who experienced shoulder dystocia.MethodA bi-monthly multi-professional 1-day intrapartum emergencies training course, that included a 30-minute practical session on shoulder dystocia management, commenced in 2000.Main OutcomesNeonatal morbidity (brachial plexus injury, humeral fracture, clavicular fracture, 5-minute Apgar score <7) and documented management of shoulder dystocia (resolution manoeuvres performed, traction applied, head-to-body delivery interval).ResultsCompliance with national guidance improved with continued training. At least one recognised resolution manoeuvre was used in 99.8% (561/562) of cases of shoulder dystocia in the late training period, demonstrating a continued improvement from 46.3% (150/324, P<0.001) pre-training, and 92% (241/262, P<0.001) in the early training period. In parallel there was reduction in the brachial plexus injury at birth (24/324 [7.4%, P<0.01], pre-training, 6/262 [2.3%] early training, and 7/562 [1.3%] late training.ConclusionsThere are significant benefits to long-term, embedded training programmes with improvements in both management and outcomes. A decade after the introduction of training there were no cases of brachial plexus injury lasting over 12months in 562 cases of shoulder dystocia.

OBJECTIVE: We sought to compare the predictive power of published modified obstetric early warning scoring systems (MOEWS) for the development of severe sepsis in women with chorioamnionitis.STUDY DESIGN: This was a retrospective cohort study using prospectively collected clinical observations at a single tertiary unit (Chicago, IL). Hospital databases and patient records were searched to identify and verify cases with clinically diagnosed chorioamnionitis during the study period (June 2006 through November 2007). Vital sign data (heart rate, respiratory rate, blood pressure, temperature, mental state) for these cases were extracted from an electronic database and the single worst composite recording was identified for analysis. Global literature databases were searched (2014) to identify examples of MOEWS. Scores for each identified MOEWS were derived from each set of vital sign recordings during the presentation with chorioamnionitis. The performance of these MOEWS (the primary outcome) was then analyzed and compared using their sensitivity, specificity, positive and negative predictive values, and receiver-operating characteristic curve for severe sepsis.RESULTS: Six MOEWS were identified. There was wide variation in design and pathophysiological thresholds used for clinical alerts. In all, 913 women with chorioamnionitis were identified from the clinical database. In all, 364 cases with complete data for all physiological indicators were included in analysis. Five women developed severe sepsis, including 1 woman who died. The sensitivities of the MOEWS in predicting the severe deterioration ranged from 40-100% and the specificities varied even more ranging from 4-97%. The positive predictive values were low for all MOEWS ranging from <2-15%. The MOEWS with simpler designs tended to be more sensitive, whereas the more complex MOEWS were more specific, but failed to identify some of the women who developed severe sepsis.CONCLUSION: Currently used MOEWS vary widely in terms of alert thresholds, format, and accuracy. Most MOEWS have not been validated. The MOEWS generally performed poorly in predicting severe sepsis in obstetric patients; in general severe sepsis was overdetected. Simple MOEWS with high sensitivity followed with more specific secondary testing is likely to be the best way forward. Further research is required to develop early warning systems for use in this setting.

Introduction Good interprofessional teamworking is essential for high quality, efficient and safe clinical care. Undergraduate interprofessional training has been advocated for many years to improve interprofessional working. However, few successful initiatives have been reported and even fewer have formally assessed their educational impact. Methods This was a prospective observational study of medical and midwifery students at a tertiary-level maternity unit. An interprofessional training module was developed and delivered by a multiprofessional faculty to medical and midwifery students, including short lectures, team-building exercises and practical simulation-based training for one obstetric (shoulder dystocia) and three generic emergencies (sepsis, haemorrhage, collapse). Outcome measures were interprofessional attitudes, assessed with a validated questionnaire (UWE Interprofessional Questionnaire) and clinical knowledge, measured with validated multiple-choice questions. Results Seventy-two students participated (34 medical, 38 midwifery). Following training median interprofessional attitude scores improved in all domains (p<0.0001), and more students responded in positive categories for communication and teamwork (69–89%, p=0.004), interprofessional interaction (3–16%, p=0.012) and interprofessional relationships (74–89%, p=0.006). Scores for knowledge improved following training for medical students (65.5% (61.8–70%) to 82.3% (79.1–84.5%) (median (IQR)) p<0.0001) and student midwives (70% (64.1–76.4%) to 81.8% (79.1–86.4%) p<0.0001), and in all subject areas (p<0.0001). Conclusions This training was associated with meaningful improvements in students’ attitudes to teamwork, and knowledge acquisition. Integrating practical tasks and teamwork training, in authentic clinical settings, with matched numbers of medical and non-medical students can facilitate learning of both why and how to work together. This type of training could be adopted widely in undergraduate healthcare education.

Introduction Research into bereavement care for families who experience perinatal death has been identified as a priority by healthcare organisations, as poor bereavement care is associated with poor long-term outcomes. Method Semi-structured interviews with bereaved parents after stillbirth, and multidisciplinary focus groups with maternity staff caring for parents. Results Recruitment rate of 75% exceeded expectations, 24 out of 32 parents agreed to participate. Early analysis suggests certain themes seem relevant to both parents and staff. While the majority of parents were positive about bereavement care, many identified weaknesses and proposed solutions including better training. Poor examples of care that distressed some parents were incomplete awareness of parents’ needs, lack of time, and inadequate shared decision-making. “The impression from the doctor was,’ I’ve got things to do. I’m off’”. When being given the news that their baby had died, parents valued an individual and empathetic approach from healthcare professionals that avoided pity or “cold calculated” communication; “Important that [healthcare professionals] can be normal, and talk, and look me in the eye”. Parents and staff differed in their approach after the diagnosis; staff appeared to automatically shift care priorities to the mother and their potential future pregnancies, whilst parents continued to focus their concerns on their baby. Conclusion Communication and decision making is challenging for staff and parents at such a difficult time. A variety of changes may be needed to improve bereavement care, so that parents and staff can understand each other and work together in a very demanding situation.

To assess the usability of virtual‐reality (VR) simulation for obstetric ultrasound trainees.

Crohn's disease affects about 1 in 200 adults. Vulvitis is a rare manifestation. The diagnosis was initially overlooked in this patient because her gastrointestinal symptoms had abated some years b...

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S484-S485 Free communication (oral) presentations O635 SENIOR CLINICIAN PRESENCE ON LABOUR WARD AND PATIENT OUTCOME: A MULTICENTER MIXED-METHODS STUDY D. Siassakos, D. SiassakosSearch for more papers by this authorJ. Angouri, J. AngouriSearch for more papers by this authorH. Hambly, H. HamblySearch for more papers by this authorK. Bristowe, K. BristoweSearch for more papers by this authorT. Draycott, T. DraycottSearch for more papers by this authorR. Fox, R. FoxSearch for more papers by this author D. Siassakos, D. SiassakosSearch for more papers by this authorJ. Angouri, J. AngouriSearch for more papers by this authorH. Hambly, H. HamblySearch for more papers by this authorK. Bristowe, K. BristoweSearch for more papers by this authorT. Draycott, T. DraycottSearch for more papers by this authorR. Fox, R. FoxSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)61065-0AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S484-S485 RelatedInformation

The objective of this study was to compare maternal and midwifery manpower effects of policies for induction of labour (IOL) postdates, using a retrospective cohort design, in a level two maternity unit in a district hospital in South-West England. Primary outcome measures included mode of delivery, admission-delivery interval, midwifery manpower use. Group I consisted of 124 women who underwent IOL at 40+10. Group II were 104 women who underwent IOL at 42 weeks' gestation and 123 women who laboured spontaneously between 40+10 and 42 weeks' gestation. The nulliparous women had a shorter admission-delivery interval when induction was planned for 42 weeks, compared with 40+10 (p = 0.003), and required less frequent use of syntocinon (p = 0.04) and of continuous fetal monitoring (p = 0.02). The caesarean rate was higher in Group I than in Group II (p 0.04) for nulliparous women only. The earlier induction policy was associated with a higher midwifery manpower requirement for nulliparae (p = 0.002). For parous women, the only difference was the greater use of oxytocin in labour. There was no difference between the groups in duration of labour, analgesia, Apgar scores, admission to neonatal care and meconium aspiration. In conclusion, delaying planned induction by three days was associated with lower medicalisation of labour and manpower needs for nulliparous women.

"Ormond's disease and vaginal varicosities." Journal of Obstetrics and Gynaecology, 31(2), pp. 190–191

From the earliest days of medical practice, when surgeons used cadavers to explore the possibilities of surgical intervention, simulation has been employed to advance the practice of health care. In the last 10 years, technological advances have allowed for a wider availability and greater realism of simulation, and this has encouraged a great expansion in its use. Simulation aims to create a virtuous cycle of professional development to improve patient outcomes. Although it seems eminently logical to believe that simulation will result in better outcomes, there is a need to test these new training interventions rigorously to be sure of their worth and to understand any limitations. The purpose of this BJOG supplement is to examine in depth several paradigms of medical simulation within maternity care and gynaecology, in different settings, looking at what can be achieved and how. In this opening review, we look at the potential use of medical simulation in broad terms and describe the types of evidence that can be employed to support its use.

"Type 2 diabetes identified in pregnancy secondary to Cushing's syndrome." Journal of Obstetrics and Gynaecology, 31(6), p. 541

Please cite this paper as: Siassakos D, Bristowe K, Draycott T, Angouri J, Hambly H, Winter C, Crofts J, Hunt L, Fox R. Clinical efficiency in a simulated emergency and relationship to team behaviours: a multisite cross‐sectional study. BJOG 2011;118:596–607.

"Limitation of proteinuria rise in diabetic pregnancy: Possible benefits of enoxaparin." Journal of Obstetrics and Gynaecology, 30(8), p. 863

Please cite this paper as: Draycott T, Sibanda T, Laxton C, Winter C, Mahmood T, Fox R. Quality improvement demands quality measurement. BJOG 2010;117:1571–1574.