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. 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 in single maternity units.

THISTLE is a multi-centre Stepped-Wedge Randomised Controlled Trial (SW-RCT), funded by the CSO assessing if the implementation of an intrapartum emergencies training package (PROMPT) across a health service reduce the rate of Apgar <7 at 5 minutes, in term babies (excluding elective caesarean births).

The primary outcome measure is the proportion of infants born with a low Apgar score (score < 7 vs. ≥7) at 5 minutes for each vaginal or emergency caesarean term birth (≥37weeks). The primary outcome was evaluated at 36 months.  PROMPT training, as implemented, had no impact on the proportion of babies with an Apgar score <7 during the study period.  Follow-up to 5 years is ongoing.

For more information please see the THISTLE Study Website





Lenguerrand, E., Winter, C., Innes, K. et al. THISTLE: trial of hands-on Interprofessional simulation training for local emergencies: a research protocol for a stepped-wedge clustered randomised controlled trial. BMC Pregnancy Childbirth 17, 294 (2017).

Lenguerrand E, Winter C, Siassakos D, et al Effect of hands-on interprofessional simulation training for local emergencies in Scotland: the THISTLE stepped-wedge design randomised controlled trial BMJ Quality & Safety 2020;29:122-134.