loading page

IMPACT OF INTRODUCING PROMPT ON PERMANENT BRACHIAL PLEXUS INJURY & TEARS °III/IV IN SHOULDER DYSTOCIA: THE HANOVER COHORT STUDY
  • +3
  • Spyridon Papageorgiou,
  • Lars Brodowski,
  • Halina Lewinski,
  • Bettina Bohnhorst,
  • Markus Flentje,
  • Constantin von Kaisenberg
Spyridon Papageorgiou
Marien-Hospital Witten
Author Profile
Lars Brodowski
Medizinische Hochschule Hannover Klinikum
Author Profile
Halina Lewinski
Medizinische Hochschule Hannover Klinikum
Author Profile
Bettina Bohnhorst
Medizinische Hochschule Hannover Klinikum
Author Profile
Markus Flentje
Medizinische Hochschule Hannover Klinikum
Author Profile
Constantin von Kaisenberg
Medizinische Hochschule Hannover Klinikum

Corresponding Author:[email protected]

Author Profile

Abstract

Objective: to test the hypothesis that PROMPT reduces permanent brachial plexus palsy and perinatal tears. Design: prospective / retrospective cohort study. Setting: Hanover Medical School, Germany. Population / Sample: a self-selected population. Methods: training period November 9 th 2017 until 31 st December 2019, control January 1 st 2004 until November 8 th 2017. Main outcome measures: shoulder dystocia, non-permanent and permanent brachial plexus injuries (BPI), perineal tears III°/ IV°, manual manoeuvres, and asphyxia. Results: there was a total of 22,640 births, shoulder dystocia increased from 48/18.031 (0.27%) to 23/4.609 (0.50%) (p=0.017), OR 1.88, 95%-CI [1.14; 3.09] whereas BPIs decreased from 7/48 (14.6%) to 1/23 (4.3%) (p=0.261). There was 1/7 (14.2%) of permanent BPI before and 0/1 (0%) case after. Perinatal asphyxia increased from 3/48 (6.3%) to 4/23 (17.4%) (p=0.23). However, adverse outcomes after one year were zero. McRoberts’ increased from 37/48 (77.1%) to 23/23 (100%) (p=0.013), OR 1.62, 95%-CI [1,33; 1,98] and internal rotation manoeuvres and manual extraction of the posterior arm from 6/48 (12.5%) to 5/23 (21.7%) (p=0.319). Episiotomies decreased from 5.267/18.031 (29.2%) to 836/4.609 (18.1%) (p<0.001) OR 0.54, 95 %-CI [0.49, 0.58], whereas perineal tears III°/IV° associated with shoulder dystocia increased from 1/48 (2.1%) to 1/23 (4.8%), (p=0.546). Vaginal operative deliveries remained constant (6.5% vs 7%). Conclusions: PROMPT significantly improves the management of shoulder dystocia and decreases permanent brachial plexus injuries, but not perinatal tears III°/IV°.