658: Shoulder dystocia response: improving neonatal outcomes

Abstract

OBJECTIVE: Safe delivery of the neonate during a shoulder dystocia event requires obstetric team collaboration to employ obstetric maneuvers to resolve the emergency. Clinical response to shoulder dystocia often remains suboptimal due to a lack of clinician education, indecisive or untimely response, poor communication, and the lack of effective teamwork. Our study tested a shoulder dystocia response and management protocol to evaluate the use of maneuvers, head to body delivery time, and occurrence of neonatal injury. STUDY DESIGN: An observational study was conducted at five sites selected to reflect diversity in geography, patient demographics, historical occurrences of neonatal injury, and birth volume. Data to calculate the occurrence of shoulder dystocia neonatal injury was gathered 1.25 years prior to implementation of the protocol (1/1/ 2010-3/31/2011) and 3.75 years after implementation (4/1/2011-12/ 31/14) and post intervention shoulder dystocia delivery summaries were used to determine head to body delivery times and maneuver utilizes. RESULTS: Post implementation of the protocol, 99% of consistently defined shoulder dystocia deliveries had a head and body delivery time within three minutes, with over 81% within one minute. Over 50% of deliveries required two maneuvers for delivery of the shoulders; with the majority (87.5%) of deliveries completed by use of a third maneuver. The rate of neonatal injury per 1000 live births decreased to 1.4 from 4.2 (p