Outcomes associated with a structured prenatal counseling program for shoulder dystocia with brachial plexus injury

Lifeline Medical Associates, Atlantic Health System, Morristown, NJ, USA.
American journal of obstetrics and gynecology (Impact Factor: 4.7). 08/2012; 207(2):123.e1-5. DOI: 10.1016/j.ajog.2012.05.023
Source: PubMed


We examined outcomes that were associated with a novel program to identify patients who are at high risk for shoulder dystocia with brachial plexus injury.
The program included a checklist of key risk factors and a multifactorial algorithm to estimate risk of shoulder dystocia with brachial plexus injury. We examined rates of cesarean delivery and shoulder dystocia in 8767 deliveries by clinicians who were enrolled in the program and in 11,958 patients of clinicians with no access to the program.
Key risk factors were identified in 1071 of 8767 mothers (12.2%), of whom 40 of 8767 women (0.46%) had results in the high-risk category. The rate of primary cesarean delivery rate was stable (21.2-20.8%; P = .57). Shoulder dystocia rates fell by 56.8% (1.74-0.75%; P = .002). The rates of shoulder dystocia and cesarean birth showed no changes in the group with no access to the program.
With the introduction of this program, overall shoulder dystocia rates fell by more than one-half with no increase in the primary cesarean delivery rate.

13 Reads

  • No preview · Article · Mar 2013 · American Journal of Obstetrics and Gynecology
  • [Show abstract] [Hide abstract]
    ABSTRACT: IntroductionA historic cohort study was conducted to evaluate satisfaction with childbirth of a macrosomic baby according to mode of delivery.Material and methodsAll 559 nulliparous women who delivered a neonate weighing >4000 g between 2008 and 2012 were included. The degree of woman's satisfaction with childbirth after elective cesarean, vaginal delivery, or cesarean during labor, was assessed using a five-level scale. Immediate neonatal and maternal outcomes were retrieved from clinical records. Long-term maternal outcomes were evaluated using four questionnaires on urinary incontinence, anal incontinence, and sexual functioning.ResultsNinety-nine women underwent elective cesarean, whereas 460 attempted a vaginal delivery. In the latter group, 276 women delivered vaginally, whereas 184 underwent a cesarean during labor. Long-term outcomes were assessed in 273 women (49%; elective cesarean, n = 55; vaginal delivery, n = 135; cesarean in labor, n = 83) after a mean 3-year follow-up. The proportion of long-term stress or mixed urinary incontinence was, respectively, 8%, 34%, and 12%, whereas that of anal incontinence was 7%, 19%, and 6%. Sexual functioning was similar in the three groups. No major neonatal complications were observed. When pooling the vaginal delivery and the cesarean in labor groups, the likelihood of being satisfied with childbirth was 63% in the “attempted vaginal delivery” group and 85% in the elective cesarean group (adjusted RR, 0.72; 95% CI, 0.61 to 0.84).Conclusions About one-third of women attempting a vaginal delivery of a macrosomic baby, would chose an elective cesarean if they could turn back time.This article is protected by copyright. All rights reserved.
    No preview · Article · Aug 2015 · Acta Obstetricia Et Gynecologica Scandinavica