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Safety in labour is a priority for women, their families and the NHS.  Over half of poor pregnancy outcomes in the UK could be prevented with better maternity care (1-3). These failings in maternity care have a significant impact on families and the NHS, as well as health and social costs.


A multi-professional and inexpensive maternity emergencies training course was developed in Bristol (PRactical Obstetric Multi-Professional Training - PROMPT).  Its use was associated with continued local improvements in several clinically important new born outcomes, improvements which had been seen earlier in two maternity units, in Melbourne, Australia and Kansas, USA.  Although the early data for PROMPT training (at single maternity units) are extremely encouraging, it is important to find out whether these improvements are seen when PROMPT is used on a larger scale (across numerous maternity units).


Scotland provides an ideal opportunity to study the effect of running the PROMPT training on a larger scale as only 5 of the 17 Scottish maternity units have undertaken PROMPT training.  Scotland also has the advantage of an established collection of information on all births at Scottish maternity units (ISD SMR 02).


The 5-minute Apgar<7 (Apgar<75) rate is an important measure of maternity care as it is associated with a considerably higher rate of cerebral palsy in later life [14], does not appear to vary in recent years with population demographics and it can be improved by training.  The Apgar score is a routine clinical assessment of the infant’s condition at birth using a scoring system in 5 categories scoring 0-10 at 1 minute, 5 minutes and 10 minutes after birth. Pilot data (from the ISD SMR 02) shows that Scotland has a high rate of Apgar<75, averaging at 1.1%, 0.23 percentage points higher than the Bristol pre-training rate.


The Bristol group demonstrated that implementation of the PROMPT training course was associated with improved compliance with clinical standards [11, 12] and a reduction in clinical error [12]. There were statistically significant improvements in patient outcomes; including a 48% reduction in Apgar<75. Retention of clinical skills at 12 months was excellent [15] and these improvements in patient outcomes, after training, have been sustained since 2004 (unpublished data).


The aim of this trial is to determine if a multi-professional training programme for maternity staff (PROMPT) is clinically effective across a health service, using Apgar<75 as outcome measure a routinely collected indicator of maternity care strongly associated with cerebral palsy.


The hypothesis being tested is: Does the implementation of an maternity emergencies training package across a health service reduce the rate of Apgar<75 in term babies (excluding elective/planned caesarean births)?