Download PDF
CC BY-NC-ND 4.0 · AJP Rep 2018; 08(04): e247-e250
DOI: 10.1055/s-0038-1675350
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Introduction of Posterior Axilla Sling Traction in Simulated Shoulder Dystocia

Julie R. Whittington
1   Division of MFM, Department of OB/GYN, Naval Medical Center Portsmouth, Portsmouth, Virginia
2   Division of MFM, Department of OB/GYN, University of Arkansas for Medical Sciences, Little Rock, Arkansas
,
Aaron T. Poole
1   Division of MFM, Department of OB/GYN, Naval Medical Center Portsmouth, Portsmouth, Virginia
› Author Affiliations Paper Presentation Poster Presentation at the Society for Maternal Fetal Medicine Annual Meeting, Dallas, TX 2/3/2018
Further Information

Publication History

19 April 2018

12 September 2018

Publication Date:
18 October 2018 (online)

   Permissions and Reprints

Abstract

Objective Aim of this study was to introduce posterior axilla sling traction (PAST) in delivering providers and nursing staff as an adjunct to the management of shoulder dystocia and evaluate comfort in performing the maneuver.

Methods A presimulation questionnaire had given to all participants. A brief training on how to perform PAST was also given. A simulated shoulder dystocia was run where usual maneuvers failed. Participants used PAST for delivery of posterior shoulder, delivery of posterior arm, and to assist with rotation. Participants were then given a post-simulation questionnaire. A Chi-squared test was used to evaluate comfort with performing the procedure pre and post-simulation.

Results Data were collected from 43 participants at pre and post-simulation. Designations (attending, resident, midwife, registered nurse) and responses were recorded to the questionnaires. There was a statistically significant increase in the number of providers and nurses who would feel comfortable using PAST for shoulder dystocia management and for rotational maneuvers. Ninety-three percent of participants would consider using PAST in future shoulder dystocia when usual maneuvers failed.

Conclusion PAST is an adjunct to management of shoulder dystocia that has not previously been taught in our facility. The majority of participants in our simulation felt comfortable with using PAST.

Keywords

simulation - shoulder dystocia - posterior axilla sling traction - obstetric emergency

Note

The authors are military service members (or employee of the U.S. Government). This work was prepared as part of their official duties. Title 17, USC, §105 provides that ‘Copyright protection under this title is not available for any work of the U.S. Government.’ Title 17, USC, §101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person's official duties.


The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.


 

  • References

  • 1 American College of Obstetricians and Gynecologists. Practice bulletin number 178: shoulder dystocia. ACOG 2017; 129 (05) e123-e133
    PubMedGoogle Scholar
  • 2 Beall MH, Spong C, McKay J, Ross MG. Objective definition of shoulder dystocia: a prospective evaluation. Am J Obstet Gynecol 1998; 179 (04) 934-937
    CrossrefPubMedGoogle Scholar
  • 3 Gherman RB, Ouzounian JG, Goodwin TM. Obstetric maneuvers for shoulder dystocia and associated fetal morbidity. Am J Obstet Gynecol 1998; 178 (06) 1126-1130
    CrossrefPubMedGoogle Scholar
  • 4 Dajani NK, Magann EF. Complications of shoulder dystocia. Semin Perinatol 2014; 38 (04) 201-204
    CrossrefPubMedGoogle Scholar
  • 5 Menticoglou SM. A modified technique to deliver the posterior arm in severe shoulder dystocia. Obstet Gynecol 2006; 108 (3, Pt 2): 755-757
    CrossrefPubMedGoogle Scholar
  • 6 Cluver CA, Hofmeyr GJ. Posterior axilla sling traction: a technique for intractable shoulder dystocia. Obstet Gynecol 2009; 113 (2, Pt 2): 486-488
    CrossrefPubMedGoogle Scholar
  • 7 Hofmeyr GJ, Cluver CA. Posterior axilla sling traction for intractable shoulder dystocia. BJOG 2009; 116 (13) 1818-1820
    CrossrefPubMedGoogle Scholar
  • 8 Cluver CA, Hofmeyr GJ. Posterior axilla sling traction for shoulder dystocia: case review and a new method of shoulder rotation with the sling. Am J Obstet Gynecol 2015; 212 (06) 784.e1-784.e7
    CrossrefPubMedGoogle Scholar
  • 9 Mannella P, Palla G, Cuttano A, Boldrini A, Simoncini T. Effect of high-fidelity shoulder dystocia simulation on emergency obstetric skills and crew resource management skills among residents. Int J Gynaecol Obstet 2016; 135 (03) 338-342
    CrossrefPubMedGoogle Scholar
  • 10 Shaddeau AK, Deering S. Simulation and shoulder dystocia. Clin Obstet Gynecol 2016; 59 (04) 853-858
    CrossrefPubMedGoogle Scholar
  • 11 Siassakos D, Crofts JF, Winter C, Weiner CP, Draycott TJ. The active components of effective training in obstetric emergencies. BJOG 2009; 116 (08) 1028-1032
    CrossrefPubMedGoogle Scholar
  • 12 Moni S, Lee C, Goffman D. Shoulder dystocia: quality, safety, and risk management considerations. Clin Obstet Gynecol 2016; 59 (04) 841-852
    CrossrefPubMedGoogle Scholar
  • 13 Gilstrop M, Hoffman MK. An update on the acute management of shoulder dystocia. Clin Obstet Gynecol 2016; 59 (04) 813-819
    CrossrefPubMedGoogle Scholar