American Journal of Obstetrics & Gynecology
Volume 197, Issue 2 , Pages 156.e1-156.e6, August 2007

Pattern and degree of forces applied during simulation of shoulder dystocia

  • Joanna F. Crofts, BMBS

      Affiliations

    • Department of Obstetrics and Gynecology, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
    • Corresponding Author InformationReprints: Dr Joanna Crofts, Research Fellow, Department of Obstetrics and Gynaecology, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK.
    • ,
  • Denise Ellis, RM

      Affiliations

    • Department of Obstetrics and Gynecology, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
    • ,
  • Mark James, MD

      Affiliations

    • Department of Obstetrics and Gynecology, Gloucestershire Hospitals NHS Trust, Gloucester Royal Hospital, Gloucester, UK
    • ,
  • Linda P. Hunt, PhD

      Affiliations

    • University Department of Clinical Sciences at South Bristol, Institute of Child Life and Health, UBHT Education Centre, Bristol, UK
    • ,
  • Robert Fox, MB

      Affiliations

    • Department of Obstetrics and Gynecology, Taunton and Somerset NHS Trust, Musgrove Park Hospital, Taunton, UK.
    • ,
  • Timothy J. Draycott, MD

      Affiliations

    • Department of Obstetrics and Gynecology, North Bristol NHS Trust, Southmead Hospital, Bristol, UK

Received 2 October 2006; received in revised form 19 December 2006; accepted 12 March 2007.

Objective

The objective of the study was to determine the level and pattern of forces applied during simulated shoulder dystocia.

Study Design

One hundred forty staff (95 midwives, 45 obstetricians) were randomized from 6 UK hospitals. Applied delivery force was measured during a standardized simulated shoulder dystocia. Maximum, average, total, and applied force gradients were calculated for each delivery.

Results

There was a wide range for all force variables: geometric mean maximum applied force 106 newtons (N) (range 6 to more than 250, n = 113), maximum force gradient 45 N/s (range 2-249, n = 113), total applied force 2954 N/s (range 33 to 14,197, n = 108), and average applied force 16 N (range 0-68, n = 108).

Conclusions

Despite participants managing the same scenario, there was great variation in the pattern and degree of traction used. High forces were applied during two thirds of simulations. Training must emphasize that maneuvers should be used to overcome shoulder dystocia while minimizing iatrogenic applied force.

Key words: brachial plexus injury, force, shoulder dystocia, simulation

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 This study was part of the SaFE Study (Simulation and Fire-Drill Evaluation), which was funded by the Patient Safety Research Programme of the Department of Health of England and Wales. The study was conducted in: Cheltenham, Gloucestershire, UK; Gloucester, Gloucestershire, UK; Bristol, Bristol, UK; Taunton, Somerset, UK; Exeter, Devon, UK; and Truro, Cornwall, UK

 Cite this article as: Crofts JF, Ellis D, James M, et al. Pattern and degree of forces applied during simulation of shoulder dystocia. Am J Obstet Gynecol 2007;197:156.e1-156.e6.

PII: S0002-9378(07)00405-X

doi:10.1016/j.ajog.2007.03.038

American Journal of Obstetrics & Gynecology
Volume 197, Issue 2 , Pages 156.e1-156.e6, August 2007

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