Shoulder dystocia without versus with brachial plexus injury: A case-control study

Department of Obstetrics and Gynecology , University of Mississippi, Mississippi, United States
Journal of Maternal-Fetal and Neonatal Medicine (Impact Factor: 1.37). 05/2007; 20(4):313-7. DOI: 10.1080/14767050601165805
Source: PubMed


To delineate factors that differentiate shoulder dystocia with and without brachial plexus injury (BPI).
A case-control study culled from an established shoulder dystocia database. Cases of shoulder dystocia-related BPI were identified and matched (1:1) with a control group of shoulder dystocia in which BPI did not result. Odds ratios (OR) and 95% confidence intervals (CI) were calculated.
From 1980 to 2002, there were 89 978 deliveries with 46 cases of dystocia and BPI. The rate of dystocia with BPI was 0.5 per 1000 births and of permanent BPI, 0.9/10 000 deliveries. The two groups were similar for maternal demographics, diabetes, gestational age, induction, use of epidural, the duration of labor, operative vaginal delivery, rate of macrosomia, and maneuvers used to relieve the dystocia. Fracture of the clavicle occurred significantly less often among those without (2%) vs. with BPI (17%; OR 0.10, 95% CI 0.01, 0.88).
Neither antepartum nor intrapartum factors can differentiate the patient who will have shoulder dystocia with vs. without BPI.

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Available from: Chad Klauser, May 07, 2015
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    • "La prédictibilité de certains facteurs de risque (dont le diabète, l'extraction instrumentale et l'antécédent de dystocie des e ´paules) reste faible même si l'acronyme DOPE (Diabete, Obesity, Postdatism, Excessive maternal weight gain) a e ´té suggéré par certains comme signal d'alarme [15]. La survenue imprévisible [51] d'une dystocie des e ´paules justifie une vigilance accrue de la part du personnel soignant devant toute femme en travail et une connaissance parfaite des manoeuvres a ` réaliser. La prévention et le traitement de la dystocie des e ´paules devraient faire l'objet d'un enseignement spécifique impliquant des travaux pratiques dans le cadre de la formation initiale et continue des sages-femmes, internes et obstétriciens [3] [52] [53]. "
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    ABSTRACT: Shoulder dystocia is one of the most dreadful complications of vaginal deliveries. The aim of this observational study was to evaluate risk factors of dystocia, maternal and neonatal complications and recurrent risk factors. Sixty-six cases of shoulder dystocia occurring between January 1998 and August 2008 in our university hospital were identified. Demographic data, labor management, management of the shoulder dystocia and neonatal outcome were recorded. The incidence of shoulder dystocia was 0.3%. Multiparity, weight gain greater than 12 kg, and post-term delivery were more present in our study group. McRoberts' manoeuver and symphyseal pressure were first realised. Brachial plexus injuries affected 9% of neonates with skeletal fractures in 7.5% of cases. Maternal morbidity was evaluated at about 8%. Twenty per cent had a recurrent shoulder dystocia. Shoulder dystocia is an obstetric emergency which requires a prompt management of trained personnel. Despite the difficulty of being able to prevent shoulder dystocia, training the obstetric staff could probably improve management of shoulder dystocia.
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