Does training in obstetric emergencies improve neonatal outcome?

Objective: To determine whether the introduction of Obstetrics Emergency Training in line with the recommendations of the Clinical Negligence Scheme for Trusts (CNST) was associated with a reduction in perinatal asphyxia and neonatal hypoxic-ischaemic encephalopathy (HIE). Design: A retrospective cohort observational study. Setting: A tertiary referral maternity unit in a teaching hospital. Population: Term, cephalic presenting, singleton infants born at Southmead Hospital between 1998 and 2003 were identified; those born by elective Caesarean sections were excluded. Method: Five-minute Apgar scores were reviewed. Infants that developed HIE were prospectively identified throughout this period. The study compared the period 'pre-training' (1998-1999), with the period 'post-training' (2001-2003). Main outcome measure: Five-minute Apgar scores and HIE. Results: Infants (19,460) were included. Infants born with 5-minute Apgar scores of <= 6 decreased from 86.6 to 44.6 per 10,000 births (P < 0.001) and those with HIE decreased from 27.3 to 13.6 per 10,000 births (P = 0.032) following the introduction of the training courses in 2000. Antepartum and intrapartum stillbirth at term rates remained unchanged, at about 15 and 4 per 10,000 births, respectively. Conclusions: The introduction of obstetric emergencies training courses was associated with a significant reduction in low 5-minute Apgar scores and HIE. This improvement has been sustained as the training has continued. This is the first time an educational intervention has been shown to be associated with a clinically important, and sustained, improvement in perinatal outcome.