Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2018 Oct;8(4):e206-e211.
doi: 10.1055/s-0038-1673377. Epub 2018 Oct 9.

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

Margaret Walters  1 , Allison Eubanks  1 , Elizabeth Weissbrod  2 , John Fischer  1 , Barton Staat  1 , Shad Deering  1
Affiliations
Case Reports

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

Margaret Walters et al. AJP Rep. 2018 Oct.

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: fetal injury; legal; shoulder dystocia; simulation; traction; training.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest None.

Figures

Fig. 1
Fig. 1
Mean force 75 and 150 N in calm environment (with standard deviation).
Fig. 2
Fig. 2
Mean force 75 and 150 N in stressed environment (with standard deviation).
Fig. 3
Fig. 3
Estimation of traction in all scenarios.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Grimm M J, Costello R E, Gonik B. Effect of clinician-applied maneuvers on brachial plexus stretch during a shoulder dystocia event: investigation using a computer simulation model. Am J Obstet Gynecol. 2010;203(04):3390–3.39E7. - PubMed
    1. Allen R, Sorab J, Gonik B. Risk factors for shoulder dystocia: an engineering study of clinician-applied forces. Obstet Gynecol. 1991;77(03):352–355. - PubMed
    1. Allen R H, Gurewitsch E D.Temporary Erb-Duchenne palsy without shoulder dystocia or traction to the fetal head Obstet Gynecol 2005105(5, Pt 2):1210–1212. - PubMed
    1. Deering S H, Weeks L, Benedetti T. Evaluation of force applied during deliveries complicated by shoulder dystocia using simulation. Am J Obstet Gynecol. 2011;204(03):2340–2.34E7. - PubMed
    1. Gonik B, Zhang N, Grimm M J. Prediction of brachial plexus stretching during shoulder dystocia using a computer simulation model. Am J Obstet Gynecol. 2003;189(04):1168–1172. - PubMed

Publication types