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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.

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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

References

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