Labour

High-fidelity simulation on shoulder dystocia management in Greek Midwives: the SAFE study (2022)

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Type of publication:
Conference abstract

Author(s):
*Papoutsis D.; Klazoglou P.; Valasoulis G.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology. Conference: Royal College of Obstetricians and Gynaecologists World Congress, RCOG 2022. London United Kingdom. 129(Supplement 1) (pp 128), 2022. Date of Publication: June 2022.

Abstract:
Objective: The SAFE study is funded from the Hellenic Foundation for Research and Innovation and its primary objective is to explore and quantify how the knowledge and skills on shoulder dystocia management of Greek Midwives may improve following high-fidelity simulation. Design(s): A high-fidelity simulator that consisted of a pelvic model and a computerised neonatal mannequin with a built in force-monitoring system was utilised for the purposes of shoulder dystocia management in a one-day workshop. Registered midwives were invited to participate in groups of five in a 90-min training session during the workshop. Method(s): The training session consisted of a 30-minute initial assessment, a 30-minute theoretical and hands-on training from the instructor, and a 30-minute final assessment of participants. The outcomes measured involved the performance of maneuvers, the force applied on the neonatal head, the level of communication skills and self-reported confidence. These outcomes were recorded at the start and end of the training session. The checklist of performance involved 20 items in accordance with the RCOG guideline on shoulder dystocia. The force applied on the neonatal head was recorded with the force-monitoring system of the simulator. The communication skills and the self reported confidence of participants were measured on a numerical scale. The pre-and after-training scores of all four outcomes were compared and statistical analysis was applied. Result(s): There were n = 6 one-day workshops with 81 midwives participating in total (October-November 2021). Their mean age was 30.6 +/- 11.1 years old (median:25 years). Prior to training, only 6/81 (7.4%) managed to successfully deliver the impacted shoulder (defined as successful delivery of the posterior arm), with this increasing to 77/81 (95%) after training. The force applied to the neonatal head was similar pre-and after-training (pre:102.20 +/- 38.1 Newtons vs after: 102.13 +/- 27.7 Newtons), with a convergence of the outliers to the mean value. Performance scores (scale:0- 20) improved significantly almost three-fold (pre:5.75 +/- 3.8 vs after:15.63 +/- 2.5), and the self-reported confidence of participants (scale:0-10) increased almost two-fold (pre:3.2 +/- 1.9 vs after: 7.8 +/- 1.4). The communication skills of the participants (scale:0-5) also improved (pre: 2.90 +/- 1.1 vs after: 4.78 +/- 0.5). Those with the most improvement in their confidence were the participants with less clinical experience (r = ?0.329, p = 0.03). Conclusion(s): High-fidelity simulation on the management of shoulder dystocia at childbirth, even after a single training session, can significantly improve the performance score of maneuvers, the levels of confidence and the communication skills of Midwives.

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The incidence of and risk factors for a repeat obstetric anal sphincter injury (OASIS) in the vaginal birth subsequent to a first episode of OASIS: a hospital-based cohort study (2017)

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Type of publication:
Journal article

Author(s):
*Antonakou, Angeliki; *Papoutsis, Dimitrios; *Henderson, Karen; *Qadri, Zahid; *Tapp, Andrew

Citation:
Archives of gynecology and obstetrics. Vol 295(5):1201-1209

Abstract:
PURPOSETo identify the incidence of and risk factors for a repeat obstetric anal sphincter injury (OASIS) in women who sustained an OASIS in their first vaginal delivery and have a subsequent vaginal birth.METHODS Data were collected retrospectively for women having had singleton cephalic presentation vaginal deliveries between 2007 and 2015. Women with breech deliveries, stillbirths, foetal congenital abnormalities and multiple pregnancies were excluded.RESULTSOver the study period, we identified 11,191 women who had a first vaginal birth, of which 603 (5.4%) sustained a first episode of OASIS. Of these women, 243 (40.2%) had a subsequent pregnancy with 190 (78.1%) having a second vaginal birth, 13 (5.4%) an emergency caesarean section (CS) delivery while in labour and 40 (16.5%) an elective CS delivery. In those who delivered vaginally, 16 (8.4%) women had a repeat OASIS. After adjusting for several confounding factors, it was found that the risk of a repeat OASIS was associated with the use of epidural analgesia (OR = 3.66; 95% CI:1.14-11.71) and an episiotomy in the first delivery (OR = 3.93; 95% CI:1. 03-15.02) and a short labour (<2.8 h) in the second delivery (OR = 14.55; 95% CI: 1.83-115.75). The time interval between the two vaginal births was not associated with any increased risk of a repeat OASIS.CONCLUSION We found that 8.4% of women sustained a repeat OASIS in a subsequent vaginal birth with this risk being associated with the presence of a short second labour and certain features from the first labour.

The effect of fetal gender on the delivery outcome in primigravidae women with induced labours for all indications (2016)

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Type of publication:
Journal article

Author(s):
Antonakou A.; *Papoutsis D.

Citation:
Journal of Clinical and Diagnostic Research; Dec 2016; vol. 10 (no. 12)

Abstract:
Introduction: There is increasing evidence of a gender-related phenomenon where the presence of a male fetus may have an adverse effect on the outcome of pregnancy. Aim: The aim of this study was to investigate the effect of fetal gender on the delivery outcome in primigravidae women with induced labours. Materials and Methods: This was an observational cohort study of primigravidae women who had Induction Of Labour (IOL) for all indications during a two-year period. Women with breech vaginal deliveries, stillbirths, multiple pregnancies and elective Caesarean Section (CS) were excluded. Results: Of the 936 eligible patients identified, 493(52.6%) gave birth to male neonates and 443(47.4%) to female neonates. Age, ethnicity, Body Mass Index (BMI) and smoking were similar between women that delivered male and female neonates. More than half of all women were induced for post-date pregnancies. In women who gave birth to male neonates, the CS delivery rate was higher than in those with female neonates (23.7% vs 17.8%; p=0.029). Though emergency admission rates to the neonatal Intensive Care Unit (ICU) and arterial/venous pH from umbilical cord sampling immediately after birth were similar between male and female neonates, nevertheless male neonates had lower Apgar scores of <7 at 1 minute after birth (p=0.02). Conclusions: This study has shown that, male gender fetuses have a higher CS delivery rate in primigravidae women undergoing IOL and may be more vulnerable to fetal compromise when in labour.

Link to more details or full-text: http://www.jcdr.net/articles/PDF/9104/22099_CE[Ra1]_F(GH)_PF1(PI_RK)_PFA(AK)_PF2(PAG).pdf