Effects of shoulder dystocia training on the incidence of brachial plexus injury

Am J Obstet Gynecol. 2011 Apr;204(4):322.e1-6. doi: 10.1016/j.ajog.2011.01.027. Epub 2011 Feb 24.


Objective: We sought to determine whether implementation of shoulder dystocia training reduces the incidence of obstetric brachial plexus injury (OBPI).

Study design: After implementing training for maternity staff, the incidence of OBPI was compared between pretraining and posttraining periods using both univariate and multivariate analyses in deliveries complicated by shoulder dystocia.

Results: The overall incidence of OBPI in vaginal deliveries decreased from 0.40% pretraining to 0.14% posttraining (P < .01). OBPI after shoulder dystocia dropped from 30% to 10.67% posttraining (P < .01). Maternal body mass index (P < .01) and neonatal weight (P = .02) decreased and head-to-body delivery interval increased in the posttraining period (P = .03). Only shoulder dystocia training remained associated with reduced OBPI (P = .02) after logistic regression analysis. OBPI remained less in the posttraining period (P = .01), even after excluding all neonates with birthweights >2 SD above the mean.

Conclusion: Shoulder dystocia training was associated with a lower incidence of OBPI and the incidence of OBPI in births complicated by shoulder dystocia.

MeSH terms

  • Birth Injuries / prevention & control*
  • Birth Weight
  • Body Mass Index
  • Brachial Plexus / injuries*
  • Cesarean Section / statistics & numerical data
  • Cohort Studies
  • Delivery, Obstetric / education*
  • Delivery, Obstetric / methods
  • Dystocia*
  • Female
  • Humans
  • Incidence
  • Infant, Newborn
  • Inservice Training*
  • Logistic Models
  • Pregnancy
  • Retrospective Studies
  • Shoulder*