Recurrent Shoulder Dystocia: Analysis of Incidence and Risk Factors

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
American Journal of Perinatology (Impact Factor: 1.91). 04/2012; 29(7):515-8. DOI: 10.1055/s-0032-1310522
Source: PubMed


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: Shoulder dystocia is an unpredictable obstetric emergency that may result in injury to the mother or fetus. The literature review shows that even the combination of obstetrical histories, prenatal risk factors and estimated fetal weight is ineffective in prospectively identifying infants whose births are complicated by dystocia of the shoulder. Exact fetal weight estimation in macrosomia remains an unsolved problem. Some formulae are better than others but none reaches an acceptable detection and positive rate in screening for macrosomia that could lead to clinical recommendation. Among babies born with macrosomia, in utero identification did not improve neonatal or maternal outcomes. Induction of labor for suspected macrosomia has not been shown to modify the incidence of shoulder dystocia among non diabetic women and the concept that prophylactic caesarean delivery as a means to prevent shoulder dystocia and avoid brachial plexus injury has not been supported by clinical data. Optimizing the management of shoulder dystocia seems actually to be the most immediate and useful approach to the prevention of birth-related brachial plexus injury.
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