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. 2024 Feb 3:2024:8712553.
doi: 10.1155/2024/8712553. eCollection 2024.

Impact of Introducing PROMPT on Permanent Brachial Plexus Injury and Tears III°/IV° in Shoulder Dystocia: The Hanover Cohort Study

Spyridon Papageorgiou  1   2 , Lars Brodowski  1 , Halina Huppertz  1 , Bettina Bohnhorst  3 , Markus Flentje  4 , Constantin von Kaisenberg  1
Affiliations

Impact of Introducing PROMPT on Permanent Brachial Plexus Injury and Tears III°/IV° in Shoulder Dystocia: The Hanover Cohort Study

Spyridon Papageorgiou et al. Obstet Gynecol Int. .

Abstract

Objective: To test the hypothesis that PROMPT reduces permanent brachial plexus palsy and perineal tears.

Design: A prospective/retrospective cohort study. Setting. Hanover Medical School, Germany. Population/Sample. A self-selected population.

Methods: The training period is from November 9th, 2017, until December 31st, 2019; control: January 1st, 2004, until November 8th, 2017. Main Outcome Measures. Shoulder dystocia, nonpermanent and permanent brachial plexus injuries (BPIs), perineal tears III°/IV°, manual manoeuvres, and asphyxia.

Results: There was a total of 22,640 births, and shoulder dystocia increased from 48/18,031 (0.27%) to 23/4,609 (0.50%) ((p=0.017), OR: 1.88, 95% CI: (1.14; 3.09)), whereas BPIs decreased from 7/48 (14.6%) to 1/23 (4.3%) (p=0.261). There was 1/7 (14.2%) of permanent BPI before and 0/1 (0%) case after. Perinatal asphyxia increased from 3/48 (6.3%) to 4/23 (17.4%) (p=0.23). However, adverse outcomes after one year were zero. McRoberts' manoeuvre increased from 37/48 (77.1%) to 23/23 (100%) ((p=0.013), OR: 1.62, 95% CI: (1.33; 1.98)), and internal rotation manoeuvres and manual extraction of the posterior arm from 6/48 (12.5%) to 5/23 (21.7%) (p=0.319). Episiotomies decreased from 5,267/18,031 (29.2%) to 836/4,609 (18.1%) ((p < 0.001), OR: 0.54, 95% CI: (0.49, 0.58)), whereas perineal tears III°/IV° associated with shoulder dystocia increased from 1/48 (2.1%) to 1/23 (4.8%) (p=0.546). Vaginal operative deliveries remained constant (6.5% vs. 7%).

Conclusions: PROMPT significantly improves the management of shoulder dystocia and decreases permanent brachial plexus injuries but not perineal tears III°/IV°.

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Conflict of interest statement

The authors declare that there are no conflicts of interest.

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References

    1. Menticoglou S. Shoulder dystocia: incidence, mechanisms, and management strategies. International Journal of Women’s Health . 2018;10:723–732. - PMC - PubMed
    1. Wagner R. K., Nielsen P. E., Gonik B. Shoulder dystocia. Obstetrics & Gynecology Clinics of North America . 1999;26(2):371–383. - PubMed
    1. Lalka A., Gralla J., Sibbel S. E. Brachial plexus birth injury: epidemiology and birth weight impact on risk factors. Journal of Pediatric Orthopaedics . 2020;40(6):E460–E465. - PubMed
    1. Dahlberg J., Nelson M., Dahlgren M. A., Blomberg M. Ten years of simulation-based shoulder dystocia training- impact on obstetric outcome, clinical management, staff confidence, and the pedagogical practice- a time series study. BMC Pregnancy and Childbirth . 2018;18(1):p. 361. - PMC - PubMed
    1. Crofts J. F., Lenguerrand E., Bentham G. L., et al. Prevention of brachial plexus injury- 12 years of shoulder dystocia training: an interrupted time-series study. BJOG: An International Journal of Obstetrics and Gynaecology . 2016;123:111–118. doi: 10.1111/1471-0528.13302. - DOI - PubMed

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