Recurrent Shoulder Dystocia: Analysis of Incidence and Risk Factors
ABSTRACT To determine the rate and associated risk factors for recurrent shoulder dystocia (SD).
A retrospective analysis was performed of patients delivered from January 1991 to June 2001. Patients with and without recurrent SD were identified and compared.
Among the 267,228 vaginal births during the study period, there were 1904 cases of SD (0.7%) and 270 patients with one additional vaginal birth. The recurrent SD rate was higher than the general population (3.7% versus 0.7%, odds ratio 7.36, 95% confidence interval 3.68 to 14.23, p < 0.001). Patients with recurrent SD had a slightly higher mean birth weight with the second delivery, but this difference was not statistically significant (4173 ± 544 g versus 4017 ± 577 g, p = 0.39).
Prior SD is a risk factor for recurrence in a subsequent delivery, but our results demonstrate that the rate appears to be lower than previously estimated. Most variables, including birth weight, do not appear to be useful parameters in predicting recurrence.
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ABSTRACT: OBJECTIVE: The objective was to determine the rate of neonatal brachial plexus palsy (NBPP) among women with vaginal birth after cesarean delivery (VBAC), and compare the peripartum characteristics with controls. STUDY DESIGN: The Maternal-Fetal Medicine Unit cesarean registry data was used to identify non-anomalous singletons at gestational age of ≥ 37 weeks (term) with VBAC and NBPP, as well as 4 controls (matched for gestational age and diabetes status but without brachial injury). Odds ratio (OR) with 95% confidence intervals (CI) were calculated. RESULTS: Among 11,313 VBAC at term there were 23 NBPP (rate of 2.0/1,000). Newborns with NBPP, compared to controls, were significantly more likely to weigh ≥ 4,000 g (48% vs. 10%, respectively; OR 8.45, 95% CI 2.58-28.44), and require admission to the neonatal intensive care unit (30% vs 13%; OR 12.98; 95% CI 2.61-72.18). CONCLUSION: Women who desire VBAC should be informed about the low rate of NBPP and if eligible, encouraged to have a trial of labor after cesarean.American journal of obstetrics and gynecology 12/2012; 208(3). DOI:10.1016/j.ajog.2012.11.042