To evaluate whether a standardized approach to identify pregnant women at risk for shoulder dystocia (SD) is associated with reduced incidence of SD and brachial plexus injury (BPI).
Between 2011 and 2015, prospective data were collected from 29 community-based hospitals in the USA during implementation of an evidence-based practice bundle, including an admission risk assessment, required “timeout” before operative vaginal delivery (OVD), and low-fidelity SD drills. All women with singleton vertex pregnancies admitted for vaginal delivery were included. Rates of SD, BPI, OVD, and cesarean were compared between a baseline period (January 2011–September 2013) and an intervention period (October 2013–June 2015), during which there was a system-wide average bundle compliance of 90%.
There was a significant reduction in the incidence of SD (17.6%; P=0.028), BPI (28.6%; P=0.018), and OVD (18.0%; P<0.001) after implementation of the evidence-based practice bundle. There was a nonsignificant reduction in primary ( P=0.823) and total ( P=0.396) cesarean rates, but no association between SD drills and incidence of BPI.
Synopsis: In a multicentered community-based hospital system, implementation of risk assessment tools was associated with decreased rates of shoulder dystocia and brachial plexus injury.