A Multicenter Assessment of 1,177 Cases of Shoulder Dystocia: Lessons Learned

Abstract The purposes of this review were to describe deliveries complicated by shoulder dystocia (SD) at three tertiary centers and discern the differences between SD with and without brachial plexus injury (BPI). The inclusion criteria for this multicenter, retrospective study were singletons, delivered vaginally with SD. To discern the risk factors for SD with and without injury, a case (SD and BPI) versus control (3 SD without injury at the same institution) design was used. Multiple linear regression was employed. Over a 7-year period, among 46,637 vaginal deliveries, SD occurred in 1,177 cases (2.5%) and BPI was noted in 11%. The results of multiple regression indicate that gestational age, operative delivery, and the number of maneuvers and concomitant fracture (4%) were statistically associated with BPI following SD (p < 0.001). SD was not associated with BPI in 89% and 88% of the cases that were resolved with McRoberts maneuver and suprapubic pressure, whereas only 0.2% of cases were litigated.

[1]  I. Meizner,et al.  Sonographic prediction of fetal macrosomia: the consequences of false diagnosis. , 2008, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[2]  R. Gherman,et al.  Newborn brachial plexus injuries: The twisting and extension of the fetal head as contributing causes , 2008, Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology.

[3]  A. Fanaroff.  Shoulder Dystocia with and without Brachial Plexus Injury: Experience from Three Centers , 2008 .

[4]  R. Gherman,et al.  Shoulder dystocia without versus with brachial plexus injury: A case–control study , 2007, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[5]  A. Ciampi,et al.  Prediction of risk for shoulder dystocia with neonatal injury. , 2006, American journal of obstetrics and gynecology.

[6]  Yvonne W. Cheng,et al.  The relationship of fetal position and ethnicity with shoulder dystocia and birth injury. , 2006, American journal of obstetrics and gynecology.

[7]  R. Sokol,et al.  What factors are associated with neonatal injury following shoulder dystocia? , 2006, Journal of Perinatology.

[8]  S. Chauhan,et al.  A scoring system for detection of macrosomia and prediction of shoulder dystocia: A disappointment , 2006, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[9]  M. Druzin.  Brachial Plexus Injury: A 23-Year Experience From a Tertiary Center , 2006 .

[10]  S. Chauhan,et al.  Suspicion and treatment of the macrosomic fetus: a review. , 2005, American journal of obstetrics and gynecology.

[11]  V. Tandon,et al.  Primiparity: A risk factor for brachial plexus injury in the presence of shoulder dystocia? , 2005, Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology.

[12]  J. Morrison,et al.  Professional liability claims and Central Association of Obstetricians and Gynecologists members: myth versus reality. , 2005, American journal of obstetrics and gynecology.

[13]  A. Satin,et al.  Improving Resident Competency in the Management of Shoulder Dystocia With Simulation Training , 2004, Obstetrics and gynecology.

[14]  S. Deering,et al.  Intrapartum risk factors for permanent brachial plexus injury. , 2003, American journal of obstetrics and gynecology.

[15]  J. Pezzullo,et al.  Effect of operative vaginal delivery on the outcome of permanent brachial plexus injury. , 2003, The Journal of reproductive medicine.

[16]  C. Spong,et al.  Prioritizing Posterior Arm Delivery During Severe Shoulder Dystocia , 2003, Obstetrics and gynecology.

[17]  P. Kannisto,et al.  Shoulder dystocia and brachial plexus injury: a case–control study , 2003, Acta obstetricia et gynecologica Scandinavica.

[18]  R. Allen.  Associated factors in 1611 cases of brachial plexus injury. , 1999, Obstetrics and gynecology.

[19]  P. Hope,et al.  Fatal shoulder dystocia: a review of 56 cases reported to the Confidential Enquiry into Stillbirths and Deaths in Infancy , 1998, British journal of obstetrics and gynaecology.

[20]  G. Hankins,et al.  Brachial plexus palsy involving the posterior shoulder at spontaneous vaginal delivery. , 1995, American journal of perinatology.