1 / 24

Shoulder Dystocia: Analysis from a Risk Management Perspective

Shoulder Dystocia: Analysis from a Risk Management Perspective. Barrett NA , Ryan HM, Mc Millan HM, Geary MP Rotunda Hospital, Dublin, Ireland. Shoulder Dystocia. Definition Background Incidence Risk Factors Clinical Manifestations Aims of Study Methods Results Conclusions.

meryle
Télécharger la présentation

Shoulder Dystocia: Analysis from a Risk Management Perspective

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Shoulder Dystocia:Analysis from a Risk Management Perspective Barrett NA, Ryan HM, Mc Millan HM, Geary MP Rotunda Hospital, Dublin, Ireland.

  2. Shoulder Dystocia • Definition • Background • Incidence • Risk Factors • Clinical Manifestations • Aims of Study • Methods • Results • Conclusions

  3. Definition • A delivery that requires additional manoeuvres to release the shoulders after gentle downward traction has failed. (RCOG Dec 2005)

  4. Definition • “Vertex delivery in which gentle lateral head traction and normal maternal pushing efforts fail to deliver the shoulders, in the absence of other causes of dystocia or slow progress” (Piper & McDonald, 1994) • “Further progress toward delivery is prevented by impaction of the fetal shoulder within or above the maternal pelvis” (Seeds, 1991 quoted by Hall, 1997)

  5. Background-Incidence • 0.6 % in Europe and North America • Variation in definitions and incomplete documentation (Simpson, 1999)

  6. Background-Risk Factors • Macrosomia • Maternal Diabetes • Hx of macrosomia/shoulder dystocia • Labour abnormalities • Instrumental deliveries • Post term • Increasing maternal age • Maternal obesity • Male fetus

  7. Background-Clinical Manifestations • Prolonged head-to-body delivery time • Turtle neck sign • Routine manoeuvres for delivery ineffective in delivery of shoulders

  8. BackgroundRisk management • Obstetric emergency potential for risk and litigation • Risk Management involves • Risk Identification • Risk analysis and monitoring • Risk evaluation • Risk treatment • Risk control (ROCG Clinical Governance Advice 2005 Improving patient safety in Obstetrics & Gynaecology)

  9. Aims • To determine local incidence • To review management • To review documentation • To review clinical neonatal outcomes • To improve risk management

  10. Methods • 2 year review of deliveries • January 2005 -December 2006 • Computerised records / birth register incident forms / neonatal register • Manual chart documentation review of individual cases

  11. Results • 80 cases • No of deliveries during this period = 14,129 • Incidence = 0.56 % • 44% (35/80) • associated with instrumental deliveries • 65% (52/80) • out of office hours

  12. Results of documentation review

  13. Results of documentation review

  14. Results- Neonatal outcomes *100% documentation

  15. Results- Neonatal outcomes Cord pH results

  16. Results-Neonatal OutcomeAdverse events • 4 cases of Erb’s palsy. • 1 case of clavicular fracture

  17. Conclusions • Poor documentation of management • Incomplete de-briefing after an incident • Review of management limited by documentation

  18. Conclusions • Reduce risk by • Improving identification of clinical risk factors • Education of staff of risk factors • Improve documentation of risk factors

  19. Conclusions • Monitor risk by audit cycle

  20. Shoulder Dystocia • Addressograph • Date__________ Form completed by__________________ • Delivery of head Spontaneous Instrumental LSCS • Call for HELP • Emergency Bleep Time • Arrival Time Name • Registrar/ spr/ cons doc y/n doc y/n • Senior Midwife doc y/n doc y/n • Paediatrician doc y/n doc y/n • Anaethesist doc y/n doc y/n • PROCEDURE USED TO ASSIST DELIVERY OF SHOULDERS • Sequence Time Performed by • Evaluate for Episiotomy • Episiotomy • McRoberts’ position • Directed Supra pubic pressure • rocking/continuous • Enter manoeuvres • Unspecified manouevres • Woods Screw • Delivery of posterior arm • Roll mother onto all fours position • Time delivery of head ________ Head facing: Left: Right: not documented • Time delivery of body _________ Cord pH and BE Arterial __________ • Cord pH and BE Venous __________ • Apgar Score 1 minute 5 minute NICU Y/N • Explanation to parents post event Yes No • Follow up after discharge Yes No • Advice for next pregnancy D Y/N LSCS/SVD • Risk factors/ND • weight

  21. Conclusions • Control risk by • A standardised proforma • Improve documentation • Improve awareness of clinical pathway for follow-up • Staff training fire-drills • Feedback sessions

  22. Thank you

  23. Setting standards to improve women’s health Royal College ofObstetricians andGynaecologists Risk Management and Medico-Legal Issues In Women’s Health Joint RCOG/ENTER Meeting Please turn off all mobile phones and pagers

More Related