Abstract
OBJECTIVE: The purpose of this study was to examine the 1-year incidence statewide in California
of shoulder dystocia and its associated risk factors.
STUDY DESIGN: With a data set that contains computer-linked records from the birth certificate
and hospital discharge records of both mother and baby, all births of infants >3500
g in >300 civilian acute care hospitals in California in 1992 were analyzed. All cases
of shoulder dystocia were identified from discharge records, birth certificates, or
both and were analyzed with both bivariate and multivariate techniques to identify
specific risk factors.
RESULTS: A total of 175,886 vaginal births of infants >3500 g were included in our database,
of which 6238 infants (3%) had shoulder dystocia. The percentages of births complicated
by shoulder dystocia for unassisted births not complicated by diabetes were 5.2% for
infants 4000 to 4250 g, 9.1% for those 4250 to 4500 g, 14.3% for 4500 to 4750, and
21.1% for those 4750 to 5000 g. Shoulder dystocia increased by approximately 35% to
45% in vacuum- or forceps-assisted births to nondiabetic mothers. Similar increases
were seen in unassisted births to diabetic mothers. The risk of shoulder dystocia
for assisted births to diabetic mothers was even more dramatic: 12.2% for infants
4000 to 4250 g, 16.7% for those 4250 to 4500 g, 27.3% for those 4500 to 4750 g, and
34.8% for those 4750 to 5000 g. After controlling for other parameters, there was
an increased risk of shoulder dystocia associated with diabetes (odds ratio 1.7),
assisted delivery (odds ratio 1.9), and induction of labor (odds ratio 1.3). Rates
of birth trauma, asphyxia, and length of stay were all increased among births complicated
by shoulder dystocia.
CONCLUSION: This information on the incidence of shoulder dystocia and associated risk factors
for a large statewide population may assist providers of obstetric care in counseling
patients when macrosomia is suspected. The inaccuracy of estimating fetal weight is
a severe limitation in attempting to establish guidelines designed to prevent shoulder
dystocia. (Am J Obstet Gynecol 1998;179:476-80.)
Keywords
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References
- Shoulder dystocia: a complication of fetal macrosomia and prolonged second state of labor and midpelvic delivery.Obstet Gynecol. 1978; 52: 526-530
- Macrosomia: maternal characteristics and infant complications.Obstet Gynecol. 1985; 66: 158-161
- The outcome of macrosomic infants weighing at least 4500 grams: Los Angeles County + University of Southern California experience.Obstet Gynecol. 1995; 85: 558-564
- Shoulder dystocia: should the fetus weighing greater than or equal to 4000 grams be delivered by cesarean section?.Am J Obstet Gynecol. 1991; 165: 831-837
- Sonographically estimated fetal weights: accuracy and limitation.Am J Obstet Gynecol. 1988; 159: 1118-1121
- The effect of maternal obesity on the accuracy of fetal weight estimation.Obstet Gynecol. 1995; 86: 102-107
- A comparison of single versus multiple growth ultrasonographic examinations in predicting birth weight.Am J Obstet Gynecol. 1994; 170: 1600-1606
- American College of Obstetricians and Gynecologists. The College, Washington1995 (Technical Bulletin No.: 218)
- Shoulder dystocia: an analysis of risks and obstetric maneuvers.Am J Obstet Gynecol. 1993; 6: 1732-1737
- Perinatal implications of shoulder dystocia.Obstet Gynecol. 1995; 86: 14-17
- A retrospective analysis of Erb’s palsy cases and their relationship to birth weight and trauma.J Matern Fetal Med. 1997; 6: 1-5
- The advanced life support in obstetrics (ALSO) course: a national program to enhance obstetrical emergency skills and to support maternity care practice.Arch Fam Med. 1994; 3: 1037-1041
Article Info
Publication History
Accepted:
January 28,
1998
Received in revised form:
December 13,
1997
Received:
March 24,
1997
Footnotes
☆From the Center for Health Services Research in Primary Care, Department of Obstetrics and Gynecology, University of California, Davis,a and the Division of Maternal and Child Health, School of Public Health, University of California, Berkeley.b
☆☆Supported by a grant from the Robert Wood Johnson Foundation through the Generalist Faculty Scholars Program.
★Reprint requests: Thomas S. Nesbitt, MD, MPH, Center for Health Services Research in Primary Care, 2221 Stockton Blvd, Sacramento, CA 95817.
★★0002-9378/98 $5.00 + 0 6/1/89108
Identification
Copyright
© 1998 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
