Does training in obstetric emergencies improve neonatal outcome?


Dr T Draycott, Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol BS10 5NB, UK.


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 ≤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.