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BJOG. 2006 Feb;113(2):177-82.

Does training in obstetric emergencies improve neonatal outcome?

Author information

1
Women's and Children's Directorate, Southmead Hospital, and Department of Clinical Science at North Bristol, University of Bristol, UK.

Abstract

OBJECTIVES:

To determine whether the introduction of Obstetrics Emergency Training in line with the recommendations of the Clinical Negligence Scheme for Trusts (CNST) was associated with a reduction in perinatal asphyxia and neonatal hypoxic-ischaemic encephalopathy (HIE).

DESIGN:

A retrospective cohort observational study.

SETTING:

A tertiary referral maternity unit in a teaching hospital.

POPULATION:

Term, cephalic presenting, singleton infants born at Southmead Hospital between 1998 and 2003 were identified; those born by elective Caesarean sections were excluded.

METHOD:

Five-minute Apgar scores were reviewed. Infants that developed HIE were prospectively identified throughout this period. The study compared the period 'pre-training' (1998-1999), with the period 'post-training' (2001-2003).

MAIN OUTCOME MEASURES:

Five-minute Apgar scores and HIE.

RESULTS:

Infants (19,460) were included. Infants born with 5-minute Apgar scores of <or=6 decreased from 86.6 to 44.6 per 10,000 births (P<0.001) and those with HIE decreased from 27.3 to 13.6 per 10,000 births (P=0.032) following the introduction of the training courses in 2000. Antepartum and intrapartum stillbirth at term rates remained unchanged, at about 15 and 4 per 10,000 births, respectively.

CONCLUSION:

The introduction of obstetric emergencies training courses was associated with a significant reduction in low 5-minute Apgar scores and HIE. This improvement has been sustained as the training has continued. This is the first time an educational intervention has been shown to be associated with a clinically important, and sustained, improvement in perinatal outcome.

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