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Decreased brachial plexus palsy after institution of shoulder dystocia protocol

Published:January 05, 2012DOI:https://doi.org/10.1016/j.ajog.2011.12.037
      To the Editors:
      In the recent study evaluating outcomes after instituting a shoulder dystocia protocol that included 5 components, the authors describe a “reduced frequency of brachial plexus palsy when a shoulder dystocia occurred.”
      • Grobman W.A.
      • Miller D.
      • Burke C.
      • Hornbogen A.
      • Tam K.
      • Costello R.
      Outcomes associated with the introduction of a shoulder dystocia protocol.
      I have several questions for the authors:
      • 1
        After institution of the protocol, did the institutional cesarean rate change?
      • 2
        Did the protocol include the use of downward traction?
      • 3
        Given the stable shoulder dystocia rate for the 3 study periods, to what do the authors ascribe the decreased brachial plexus palsy rates after institution of the protocol?
      If the brachial plexus injuries were related to the shoulder dystocia event and not traction by the provider, would the authors have expected the brachial plexus palsy rate to have remained stable?

      Reference

        • Grobman W.A.
        • Miller D.
        • Burke C.
        • Hornbogen A.
        • Tam K.
        • Costello R.
        Outcomes associated with the introduction of a shoulder dystocia protocol.
        Am J Obstet Gynecol. 2011; 205: 513-517

      Linked Article

      • Outcomes associated with introduction of a shoulder dystocia protocol
        American Journal of Obstetrics & GynecologyVol. 205Issue 6
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          The objective of this study was to assess outcomes that are associated with the implementation of a shoulder dystocia protocol that is focused on team response. We identified women who had a shoulder dystocia during 3 time periods: 6 months before (period A), 6 months during (period B), and 6 months after (period C) the institution of a shoulder dystocia protocol. Documentation and health outcomes were compared among the time periods. During the study period, 254 women (77, 100, and 77 in periods A, B, and C, respectively) had a shoulder dystocia.
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        American Journal of Obstetrics & GynecologyVol. 206Issue 5
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          We would like to thank Dr Jelsema for his interest in our article1 as well as the questions he has asked. During time periods A, B, and C of the study, the cesarean rates were 27.1%, 28.2%, and 29%, respectively. This change in the point estimate was not statistically significant (P = .12). Even if statistical significance had been reached, we do not believe this would explain a decrease in the frequency of brachial plexus palsy documented given the denominator for the frequency was “per shoulder dystocia,” and that the frequency of shoulder dystocia per delivery did not change over time.
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