(331) Impact of Structured Shoulder Dystocia Training on Rates of Neonatal Injuries at an Academic Institution

Objective:
To reduce the number of neonatal injuries, namely clavicular fractures and brachial plexus injuries, associated with shoulder dystocia through structured education and simulation-based training of OB/GYN residents and nursing.

Study Design:
A multidisciplinary educational initiative was implemented over a 4-month period (May-August 2024) in response to a February 2024 NICU concern about rising rates of brachial plexus injuries and clavicular fractures in 2023. Interventions included assigned reading and video review on shoulder dystocia management at the start of each new 6-week resident L&D rotation. In August 2024, didactic sessions and small-group simulation stations focused on shoulder dystocia were conducted, with continued focus on hands-on training through recurring faculty-led shoulder dystocia drills involving OB/GYN residents and nursing.

Results:
Ten months of delivery data before and after implementation were reviewed. The incidence of shoulder dystocia complicated by neonatal injury decreased from 0.45% to 0.18% of all deliveries (OR 2.5, 95% CI 0.84 – 8.97; p = 0.097). Notably, the number of deliveries complicated by shoulder dystocia increased from 63 pre-intervention to 108 post-intervention, yet the number of associated neonatal injuries (clavicular fractures and brachial plexus injuries) declined from 13 to 5 which corresponds to a 16% decline in neonatal injury in the setting of shoulder dystocia (OR 5.3, 95% CI 1.66–20.06; p < 0.01).

Conclusion:
Structured and recurrent education, particularly hands-on, simulation-based training, was associated with an increased recognition of shoulder dystocia and a reduction in neonatal injury. These findings support the continued use of simulation-based training to improve perinatal outcomes and support the application of this training model to other obstetric emergencies.