Article

Shoulder dystocia: what is the risk of recurrence?

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.
Acta Obstetricia Et Gynecologica Scandinavica (Impact Factor: 1.85). 01/2008; 87(10):992-7. DOI: 10.1080/00016340802415614
Source: PubMed

ABSTRACT To study the recurrence risk of shoulder dystocia in women who have previously experienced at least once shoulder dystocia.
A retrospective study of vaginal deliveries complicated by shoulder dystocia. Setting. American University of Beirut Medical Center - Lebanon.
Vaginal deliveries complicated by shoulder dystocia over a 15-year period who had subsequent vaginal delivery. Methods. Charts of index and subsequent deliveries beyond 24 weeks' gestation were reviewed for demographics and intrapartum events. Women were divided into those with recurrent shoulder dystocia (group I) and those with uncomplicated subsequent delivery (group II) and compared.
Recurrent shoulder dystocia and characteristics of women with recurrence.
The incidence of shoulder dystocia was 0.9% of all vaginal deliveries. Of 193 shoulder dystocia cases, 48 women had a subsequent delivery. After excluding cesarean deliveries (n=4), 44 women were analyzed. Eleven had recurrent shoulder dystocia (25.0%). Mean birthweight was larger (4,019+/-430 vs. 3,599+/-398 g, p=0.005) with a higher rate of macrosomia > or =4,000 g (63.6 vs. 15.2%, p=0.004) and the birthweight in the subsequent pregnancy was larger than the index pregnancy in a significantly larger proportion of women in group I compared with group II (72.7% vs. 33.3%, p=0.035). Otherwise, maternal age, gestational age at delivery, parity, duration of labor, gender, history of macrosomia, and interval between pregnancies were similar.
The risk of recurrence of shoulder dystocia is around 25%. When counseling women about recurrence risk, the absence of macrosomia and a smaller birthweight than the previous pregnancy could be reassuring.

0 Bookmarks
 · 
118 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: To examine risk factors for birth injury in a subsequent vaginal delivery among women with a prior delivery complicated by shoulder dystocia. Population-based retrospective cohort study, Washington State (1987-2007). Logistic regression was used to assess risk factors associated with subsequent birth injury. Of 9232 women who met inclusion criteria, 223 (2.4%) had a subsequent vaginal delivery with birth injury. Birth injury in an index delivery, adjusted odds ratio (aOR) 2.6 [95% confidence interval (CI) 1.7-4.1] and factors in subsequent delivery: birth weight ≥4000 g, aOR 4.4 (95% CI: 3.0-6.3), gestational diabetes, aOR 1.9 (95% CI: 1.2-3.2), Hispanic ethnicity aOR 1.9 (95% CI: 1.2-2.9), and maternal obesity, aOR 1.8 (95% CI: 1.3-2.6) were associated with birth injury. Among women with prior delivery complicated by shoulder dystocia, the risk factors identified in this study should be carefully considered prior to deciding upon route of delivery - cesarean vs. vaginal delivery.
    Journal of Perinatal Medicine 08/2011; 39(6):709-15. · 1.95 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To assess the impact of dengue infection during pregnancy on birth outcomes, we conducted a systematic review of 30 published studies (19 case reports, 9 case series, and 2 comparison studies). Studies were identified by searching computerized databases using dengue and dengue hemorrhagic fever, cross-referenced with pregnancy, preterm birth or delivery, low birth weight, small-for-gestational age, spontaneous abortion, pre-eclampsia, eclampsia, or fetal death as search terms. The case reports examined showed high rates of cesarean deliveries (44.0%) and pre-eclampsia (12.0%) among women with dengue infection during pregnancy, while the case series showed elevated rates of preterm birth (16.1%) and cesarean delivery (20.4%). One comparative study found an increase in low birth weight among infants born to women with dengue infections during pregnancy, compared with infants born to noninfected women. Vertical transmission was described in 64.0% and 12.6% of women in case reports and case series (respectively), as well as in one comparative study. The authors conclude that there is a risk of vertical transmission, but whether maternal dengue infection is a significant risk factor for adverse pregnancy outcomes is inconclusive. More comparative studies are needed. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this educational activity, the participant should be better able to assess symptoms of dengue fever and locations where dengue fever occurs, describe possible perinatal complications of maternal dengue fever, and identify the limitations of available literature describing dengue fever in pregnancy.
    Obstetrical & gynecological survey 02/2010; 65(2):107-18. · 3.10 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The goals of this review were to determine the incidence of recurrent shoulder dystocia and the incidence of brachial plexus injury in such cases. A search of PubMed was conducted between 1980 and March 2009. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. The search yielded 191 publications, of which 9 provided complete data; these were used to calculate the incidence of recurrent shoulder dystocia. The rate of shoulder dystocia in the prior pregnancies was 1.64% (31,311/1,911,014). Among 10,591 known subsequent vaginal births, the rate of recurrent shoulder dystocia was 12% (OR, 8.25; 95% CI, 7.77, 8.76). Brachial plexus injury occurred significantly more often during recurrent shoulder dystocia than during the first shoulder dystocia (4% vs. 1%; OR, 3.59; 95% CI, 2.44, 5.29; or 45/1000 vs. 13/1000 births). About 12% of parturients with a history of shoulder dystocia have a recurrent dystocia in the subsequent pregnancy, a risk of about 1 in 8. Brachial plexus injury occurs in 19/1000 vaginal births during the first episode of shoulder dystocia, and in 45/1000 vaginal births after recurrent dystocia. Obstetricians & Gynecologist, Family Physicians. After completion of this educational activity, the reader will be able to compare the risk of primary versus recurrent shoulder dystocia. Formulate counseling and treatment strategies for pregnant women who have had a prior pregnancy complicated by shoulder dystocia. Assess the strength of the evidence suggesting the risk of recurrent shoulder dystocia.
    Obstetrical & gynecological survey 03/2010; 65(3):183-8. · 3.10 Impact Factor