Impact of Introducing PROMPT on Permanent Brachial Plexus Injury and Tears III°/IV° in Shoulder Dystocia: The Hanover Cohort Study.

OBJECTIVE: To test the hypothesis that PROMPT reduces permanent brachial plexus palsy and perineal tears.

DESIGN: A prospective/retrospective cohort study. Setting . Hanover Medical School, Germany. Population/Sample . A self-selected population.

METHODS: The training period is from November 9th , 2017, until December 31st , 2019; control: January 1st , 2004, until November 8th , 2017. Main Outcome Measures . Shoulder dystocia, nonpermanent and permanent brachial plexus injuries (BPIs), perineal tears III°/IV°, manual manoeuvres, and asphyxia.

RESULTS: There was a total of 22,640 births, and 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' manoeuvre 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 perineal tears III°/IV°.