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An audit and reaudit of the management of shoulder dystocia: an incomplete audit cycle
  1. T Hamouda,
  2. P Giamougiannis,
  3. E Toeima,
  4. D Fraser
  1. Norfolk & Norwich University Hospital NHS Foundation trust, Norwich, Norfolk, UK


Introduction Shoulder dystocia is a common and unpredictable complication of vaginal delivery affecting 1 in 300–500 deliveries. Good management of the delivery minimises the risk of trauma.

First auditSecond reaudit
Year2nd half 20072nd half 2008
Number of notes audited3848
Call for help22/38 (58%)27/48 (56%)
Suprapubic pressure17/38 (47%)20/48 (41%)
Mc Roberts37/38 (97%)45/48 (93%)
Episiotomy16/38 (42%)18/48 (37%)
pH25/38 (65%)32/48 (66%)
Anterior Shoulder03/38 (07%)08/48 (16%)
Incident form10/38 (26%)17/48 (35%)
Paeds attended13/38 (34%)22/48 (45%)
Emergency chart filled05/48 (10%

Comparison between two audits

Aim The management of shoulder dystocia was audited during 2007 and reaudited in 2008 to ensure that it complies with Trust and Royal College of Obstetricians and Gynaecologists guidelines and to complete the audit cycle. In the first audit the authors advised 100% compliance with standards and to use the emergency chart for shoulder dystocia.

Comments There was little difference in most of the results when compared with the previous audit. The emergency chart was used only in five cases. There was some improvement in documenting which shoulder was anterior. Generally the authors are performing significantly worse than the target (100%).

Recommendations To make medical and midwifery staff aware of the importance of using the emergency chart in all cases labelled as having shoulder dystocia.

Reaudit on the management of shoulder dystacia by the end of 2010.

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