Análisis de prácticas y protocolos de formación de equipos obstétricos en distocia de hombros en hospitales españoles

Abstract

Introduction

Shoulder dystocia (SD) is an emergency with risks for mother and newborn. The training of professionals in its resolution is essential to reduce morbidity and mortality and simulation is considered a useful strategy to improve the training of obstetric teams. The aim of this study was to determine the training status of obstetric interprofessional teams in the resolution of shoulder dystocia in hospitals belonging to the Spanish Obstetric Safety Group (GESO).

Materials and methods

A specific survey was carried out between June and December 2023 in hospitals belonging to the GESO group to assess training in SD, addressing protocols, case registry and training programs.

Results

Of the 71 hospitals surveyed, 94,4% responded. These hospitals, mostly public (88%) performed 121,141 deliveries during 2022, representing 37,5% of births in Spain. The incidence of SD was 1.79% and the incidence of obstetric brachial palsy at discharge was 1,08/1000 vaginal deliveries. Regarding the management of SD, 85,1% of the hospitals follow a specific protocol and 88,1% record these cases. Regarding simulation training, 55,2% have programs, 35% of which are voluntary and annual, 5.4% are mandatory and biannual and 2.7% are mandatory and annual. 73,1% have accredited instructors (219 in total between midwives and obstetricians) and 85,1% have their own simulators.

Conclusion

The survey has revealed hitherto unavailable information on the training of obstetric teams and on the frequency and management of SD. Protocols exist in practically all the hospitals surveyed and the number of available SD simulation instructors in the country is noteworthy. Nevertheless, current training programs have room for improvement in order to meet international standards.