Volume 116, Issue 8 p. 1089-1096
General obstetrics

Retrospective cohort study of diagnosis–delivery interval with umbilical cord prolapse: the effect of team training

D Siassakos

D Siassakos

Department of Obstetrics and Gynaecology, Southmead Hospital, and Medical Education, University of Bristol, Bristol, UK

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Z Hasafa

Z Hasafa

Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK

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T Sibanda

T Sibanda

Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK

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R Fox

R Fox

Department of Obstetrics and Gynaecology, Taunton and Somerset Hospital, Bristol, UK

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F Donald

F Donald

Department of Anaesthesia, Southmead Hospital, Bristol, UK

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C Winter

C Winter

Southmead Hospital, Bristol, UK

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T Draycott

T Draycott

Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK

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First published: 10 June 2009
Citations: 171
D Siassakos, Research SpR in Obstetrics and Gynaecology, Southmead Hospital, and Clinical Lecturer (Hon) in Medical Education, University of Bristol, Bristol, UK. Email [email protected]

Department: Women’s Health, Chilterns, Southmead Hospital, Westbury on Trym, BS10 5NB

Abstract

Objective To determine whether the introduction of multi-professional simulation training was associated with improvements in the management of cord prolapse, in particular, the diagnosis–delivery interval (DDI).

Design Retrospective cohort study.

Setting Large tertiary maternity unit within a University Hospital in the United Kingdom.

Sample All cases of cord prolapse with informative case record: 34 pre-training, 28 post-training.

Methods Review of hospital notes and software system entries; comparison of quality of management for umbilical cord prolapse pre-training (1993–99) and post-training (2001–07).

Main outcome measures Diagnosis–delivery interval; proportion of caesarean section (CS) in whom actions were taken to reduce cord compression; type of anaesthesia for CS births; rate of low (<7) 5-minute Apgar scores; rate of admission to neonatal intensive care unit (NICU) (if birthweight >2500 g).

Results After training, there was a statistically significant reduction in median DDI from 25 to 14.5 minutes (P < 0.001). Post-training, there was also a statistically significant increase in the proportion of CS where recommended actions had been performed (from 34.78 to 82.35%, P = 0.003). There was a nonsignificant increase in the use of spinal anaesthesia for CS, from 8.70 to 17.65%, and a nonsignificant reduction in the rate of low Apgar scores from 6.45 to 0% and in the rate of admission to NICU from 38.46 to 22.22%.

Conclusions The introduction of annual training, in accordance with national recommendations, was associated with improved management of cord prolapse. Future studies could assess whether this improved management translates into better outcomes for babies and their mothers.