Sienas Laura E, Hedriana Herman L, Wiesner Suzanne, Pelletreau Barbara, Wilson Machelle D, Shields Laurence E
Department of Obstetrics and Gynecology, University of California Davis, Sacramento, CA, USA.
Sacramento Maternal-Fetal Medicine Medical Group, Sacramento, CA, USA.
Int J Gynaecol Obstet. 2017 Feb;136(2):162-167. doi: 10.1002/ijgo.12034. Epub 2016 Nov 21.
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 delivery 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.
Implementation of a standard evidence-based practice bundle was found to be associated with a significant reduction in the incidence of SD and BPI. Utilization of low-fidelity drills was not associated with a reduction in BPI.
评估一种用于识别肩难产（SD）高危孕妇的标准化方法是否与SD和臂丛神经损伤（BPI）发生率的降低相关。
2011年至2015年期间，在美国29家社区医院实施基于证据的实践方案时收集前瞻性数据，该方案包括入院风险评估、手术阴道分娩（OVD）前要求的“暂停”以及低保真度的SD演练。纳入所有因阴道分娩入院的单胎头位妊娠妇女。比较基线期（2011年1月至2013年9月）和干预期（2013年10月至2015年6月）之间的SD、BPI、OVD和剖宫产率，在干预期全系统平均方案依从率为90%。
实施基于证据的实践方案后，SD发生率（17.6%；P=0.028）、BPI发生率（28.6%；P=0.018）和OVD发生率（18.0%；P<0.001）显著降低。初次剖宫产率（P=0.823）和总剖宫产率（P=0.396）有非显著性降低，但SD演练与BPI发生率之间无关联。
发现实施标准的基于证据的实践方案与SD和BPI发生率的显著降低相关。使用低保真度演练与BPI发生率的降低无关。
