Visual Estimation of Force Applied During Simulated Deliveries Complicated by Shoulder Dystocia

Abstract

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

Keywords

shoulder dystocia - training - traction - fetal injury - simulation - legal

Disclaimer

The views expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy Department of the Army, Department of the Air Force, Department of Defense, or the United States Government.

Several of the authors are military service members. This work was prepared as part of their official duties. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person's official duties.

Meeting Presentations

This article was presented at ACOG Armed Forces District, October 2015, Norfolk, VA.

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