Visual estimation of force applied during simulated deliveries complicated by shoulder dystocia

Abstract

Background b-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 b-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 b-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 b-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 b-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 b-Observers are unable to determine when excessive traction is applied to the fetal head during simulated deliveries complicated by shoulder dystocia.