Objective
The objective of the study was to determine whether a decrease in the use of episiotomy
was associated with a change in the frequency of brachial plexus injury.
Study Design
All births at Brigham and Women's Hospital from Sept. 1, 1998, through Aug. 31, 2009,
were reviewed. The total number of births, mode of delivery, shoulder dystocias, episiotomies
with and without shoulder dystocias, and brachial plexus injuries were recorded. A
nonparametric test of trend was performed.
Results
There were a total of 94,842 births, 953 shoulder dystocias, and 102 brachial plexus
injuries. The rate of episiotomy with shoulder dystocia dropped from 40% in 1999 to
4% in 2009 (P = .005) with no change in the rate of brachial plexus injuries per 1000 vaginal births.
Conclusion
Despite historical recommendations for an episiotomy to prevent brachial plexus injury
when a shoulder dystocia is encountered, the trend we observed does not suggest benefit
from this practice.
Key words
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Article info
Publication history
Published online: April 15, 2011
Accepted:
April 5,
2011
Received in revised form:
March 7,
2011
Received:
January 12,
2011
Footnotes
Cite this article as: Paris AE, Greenberg JA, Ecker JL, et al. Is an episiotomy necessary with a shoulder dystocia? Am J Obstet Gynecol 2011;205:217.e1-3.
Identification
Copyright
© 2011 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
