Retrospective cohort study of diagnosis–delivery interval with umbilical cord prolapse: the effect of team training
D Siassakos
Department of Obstetrics and Gynaecology, Southmead Hospital, and Medical Education, University of Bristol, Bristol, UK
Search for more papers by this authorZ Hasafa
Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK
Search for more papers by this authorT Sibanda
Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK
Search for more papers by this authorR Fox
Department of Obstetrics and Gynaecology, Taunton and Somerset Hospital, Bristol, UK
Search for more papers by this authorF Donald
Department of Anaesthesia, Southmead Hospital, Bristol, UK
Search for more papers by this authorT Draycott
Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK
Search for more papers by this authorD Siassakos
Department of Obstetrics and Gynaecology, Southmead Hospital, and Medical Education, University of Bristol, Bristol, UK
Search for more papers by this authorZ Hasafa
Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK
Search for more papers by this authorT Sibanda
Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK
Search for more papers by this authorR Fox
Department of Obstetrics and Gynaecology, Taunton and Somerset Hospital, Bristol, UK
Search for more papers by this authorF Donald
Department of Anaesthesia, Southmead Hospital, Bristol, UK
Search for more papers by this authorT Draycott
Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK
Search for more papers by this authorDepartment: 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.
References
- 1 Nielsen PE, Goldman MB, Mann S, Shapiro DE, Marcus RG, Pratt SD, et al. Effects of teamwork training on adverse outcomes and process of care in labor and delivery: a randomized controlled trial. Obstet Gynecol 2007; 109: 48–55.
- 2 Joint Commission on Accreditation of Healthcare Organizations. Preventing infant death and injury during delivery (Sentinel Event Alert Issue #30); 21 July 2004 [http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_30.htm]. Accessed 28 October 2008.
- 3 Confidential Enquiry into Maternal and Child Health. Why Mothers Die 2000–2002. The Sixth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. London: RCOG Press, 2004.
- 4 G Lewis, editor. The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers’ Lives: Reviewing Maternal Deaths to Make Motherhood Safer––2003–2005. The Seventh Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. London: CEMACH, 2007.
- 5 Maternal and Child Health Research Consortium. The “4kg and over” Enquiries 1997. Confidential Enquiries into Stillbirths and deaths in infancy 6th Annual Report. London: Maternal and Child Health Consortium, 1999.
- 6 Maternal and Child Health Research Consortium. Breech Presentation at Onset of Labour. Confidential Enquiries into Stillbirths and deaths in infancy 7th Annual Report. London: Maternal and Child Health Consortium, 2000.
- 7 Maternal and Child Health Research Consortium. Antepartum term stillbirths. Confidential Enquiries into Stillbirths and deaths in infancy 5th Annual Report. London: Maternal and Child Health Consortium, 1998.
- 8 Critchlow CW, Leet TL, Benedetti TJ, Daling JR. Risk factors and infant outcomes associated with umbilical cord prolapse: a population-based case–control study among births in Washington State. Am J Obstet Gynecol 1994; 170: 613–8.
- 9 Murphy DJ, MacKenzie IZ. The mortality and morbidity associated with umbilical cord prolapse. Br J Obstet Gynaecol 1995; 102: 826–30.
- 10 Siassakos D, Fox R, Draycott TJ, for the Guidelines and Audit Committee of the Royal College of Obstetricians and Gynaecologists. Umbilical Cord Prolapse. Clinical Guideline Green-Top Guideline No.26. London: RCOG, 2008.
- 11 Pierre F, Rudigoz RC. Emergency caesarean delivery: is there an ideal decision-to-delivery interval? J Gynecol Obstet Biol Reprod 2008; 37: 41–7.
- 12 Tuffnell DJ, Wilkinson K, Beresford N. Interval between decision and delivery by caesarean section––are current standards achievable? Observational case series. BMJ 2001; 322: 1330–3.
- 13 Sayegh I, Dupuis O, Clement HJ, Rudigoz RC. Evaluating the decision-to-delivery interval in emergency caesarean sections. Eur J Obstet Gynecol Reprod Biol 2004; 116: 28–33.
- 14 Livermore LJ, Cochrane RM. Decision to delivery interval: a retrospective study of 1,000 emergency caesarean sections. J Obstet Gynaecol 2006; 26: 307–10.
- 15 Siassakos D, Van de Venne M, Sellers S, Moxham J, Miles J. Audit to Assess the Caesarean Section Decision-to-Delivery Interval. Glasgow, Scotland: SpROGs, 2006.
- 16 NHS Litigation Authority. Clinical negligence scheme for trusts: maternity standards. Criterion 4.1.1. 2006 [http://www.nhsla.com]. Accessed 29 May 2006.
- 17 Clinical Negligence and Other Risks Indemnity Scheme. Revised Risk Management Standards V4/2003, Standard 9 [http://www.cnoris.com]. Accessed 27 March 2009.
- 18 Children's Health & Social Care Directorate, Welsh Assembly Government. Standard 5, Maternity. National Service Framework for Children, Young People and Maternity Services in Wales. Cardiff: Welsh Assembly; 2005 [http://www.wales.nhs.uk/sites3/Documents/441/EnglishNSF_amended_final.pdf]. Accessed 27 March 2009.
- 19 Crofts JF, Bartlett C, Ellis D, Winter C, Donald F, Hunt LP, et al. Patient-actor perception of care: a comparison of obstetric emergency training using manikins and patient-actors. Qual Saf Health Care 2008; 17: 20–4.
- 20 Barnfield S, Brooks A, Bisson D, Akande A, Draycott T. Mannequins can be used to assess competencies for ventouse deliveries. Simul Health Care 2007; 2: 209.
- 21 Siassakos D, Kenyon C, O’Brien K, Draycott T. Shoulder dystocia training for medical students. BJOG 2008; 115 (Suppl 1):42.
- 22 Draycott T, Winter C, Crofts J, Barnfield S. PRactical Obstetric Multiprofessional Training (PROMPT) Trainer’s Manual. London: RCOG Press, 2008.
- 23 von Elm E, Altman DG, Egger M, Pocock SJ, Gψtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370: 1453–7.
- 24 Thomas J, Paranjothy S, Royal College of Obstetricians and Gynaecologists Clinical Effectiveness Support Unit. The National Sentinel Caesarean Section Audit Report. London: RCOG Press, 2001.
- 25 Brown CA, Lilford RJ. The stepped wedge trial design: a systematic review. BMC Med Res Methodol 2006; 6: 54.
- 26 Pratt S, Mann S, Salisbury M, Greenberg P, Marcus R, Stabile B, et al. Impact of CRM-based team training on obstetric outcomes and clinicians’ patient safety attitudes. Jt Comm J Qual Patient Saf 2007; 33: 720–5.
- 27 Clark SL, Belfort MA, Dildy GA, Meyers JA. Reducing obstetric litigation through alterations in practice patterns. Obstet gynecol 2008; 112: 1279–83.
- 28 Moriarty KT, Onwuzurike B, Jones JJ, Jones MH. The 30 minutes decision-to-delivery interval for ‘urgent’ caesarean sections: an elusive target. J Obstet Gynaecol 2006; 26: 736–9.
- 29 Bloom SL, Leveno KJ, Spong CY, Gilbert S, Hauth JC, Landon MB, et al. Decision-to-incision times and maternal and infant outcomes. Obstet Gynecol 2006; 108: 6–11.
- 30 le Riche H, Hall D. Non-elective Caesarean section: how long do we take to deliver? J Trop Pediatr 2005; 51: 78–81.
- 31 Onah HE, Ibeziako N, Umezulike AC, Effetie ER, Ogbuokiri CM. Decision-delivery interval and perinatal outcome in emergency caesarean sections. J Obstet Gynaecol 2005; 25: 342–6.
- 32 Chauhan SP, Roach H, Naef RW 2nd, Magann EF, Morrison JC, Martin JN Jr. Cesarean section for suspected fetal distress. Does the decision-incision time make a difference?. J Reprod Med 1997; 42: 347–52.
- 33 Ellis D, Crofts JF, Hunt LP, Read M, Fox R, James M. Hospital, simulation center, and teamwork training for eclampsia management: a randomized controlled trial. Obstet Gynecol 2008; 111: 723–31.
- 34 Thomas J, Paranjothy S, James D. National cross sectional survey to determine whether the decision to delivery interval is critical in emergency caesarean section. BMJ 2004; 328: 665–7.
- 35 National Collaborating Centre for Women’s and Children’s Health. Caesarean section. Commissioned by the National Institute for Clinical Excellence (NICE). London: RCOG Press, 2004.
- 36 Popham P, Buettner A, Mendola M. Anaesthesia for emergency caesarean section, 2000–2004, at the Royal Women’s Hospital, Melbourne. Anaesth Intensive Care 2007; 35: 74–9.
- 37 Afolabi B, Lesi FEA, Merah NA. Regional versus general anaesthesia for caesarean section. Cochrane Database Syst Rev 2006; 4:CD004350. DOI: DOI: 10.1002/14651858.
- 38 Scrutton M. Cord prolapse demands general anaesthesia: cons. Int J Obstet Anesth 2003; 12: 290–2.
- 39 Helmy WH, Jolaoso AS, Ifaturoti OO, Afify SA, Jones MH. The decision-to-delivery interval for emergency caesarean section: is 30 minutes a realistic target? BJOG 2002; 109: 505–8.
- 40 Holcroft CJ, Graham EM, Aina-Mumuney A, Rai KK, Henderson JL, Penning DH. Cord gas analysis, decision-to-delivery interval, and the 30-minute rule for emergency cesareans. J Perinatol 2005; 25: 229–35.
- 41 Rijnders M, Baston H, Schonbeck Y, van der Pal K, Prins M, Green J, et al. Perinatal factors related to negative or positive recall of birth experience in women 3 years postpartum in the Netherlands. Birth 2008; 35: 107–16.
- 42 Kirke PN. Mothers’ views of care in labour. Br J Obstet Gynaecol 1980; 87: 1034–8.
- 43 Kirke PN. Mothers’ views of obstetric care. Br J Obstet Gynaecol 1980; 87: 1029–33.
- 44 Decker PJ. The hidden competencies of healthcare: why self-esteem, accountability, and professionalism may affect hospital customer satisfaction scores. Hosp Top 1999; 77: 14–26.
- 45 Hickson GB, Clayton EW, Entman SS, Miller CS, Githens PB, Whettengoldstein K, et al. Obstetricians prior malpractice experience and patients satisfaction with care. JAMA 1994; 272: 1583–7.
- 46 Hickson GB, Clayton EW, Githens PB, Sloan FA. Factors that prompted families to file medical malpractice claims following perinatal injuries. JAMA 1992; 267: 1359–63.
- 47 Hillan EM. Issues in the delivery of midwifery care. J Adv Nurs 1992; 17: 274–8.
- 48 Strachan BC, Crofts J, James M, Akande V, Hunt L, Ellis D, Harris M, et al. Proof of Principle Study of the Effect of Individual and Team Drill on the Ability of Labour Ward Staff to Manage Acute Obstetric Emergencies. , Birmingham, UK: PSRP, Department of Health, Public Health, Epidemiology & Biostatistics, University of Birmingham, 2008.