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 9(th), 2017, until December 31(st), 2019; control: January 1(st), 2004, until November 8(th), 2017. Main Outcome Measures. Shoulder dystocia, nonpermanent and permanent brachial plexus injuries (BPIs), perineal tears III degrees/IV degrees, 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%) ((), OR: 1.88, 95% CI: (1.14; 3.09)), whereas BPIs decreased from 7/48 (14.6%) to 1/23 (4.3%) (). 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%) (). However, adverse outcomes after one year were zero. McRoberts' manoeuvre increased from 37/48 (77.1%) to 23/23 (100%) ((), 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%) (). Episiotomies decreased from 5,267/18,031 (29.2%) to 836/4,609 (18.1%) ((), OR: 0.54, 95% CI: (0.49, 0.58)), whereas perineal tears III degrees/IV degrees associated with shoulder dystocia increased from 1/48 (2.1%) to 1/23 (4.8%) (). 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 degrees/IV degrees.