A new approach to predicting shoulder dystocia: fetal clavicle measurement

Abstract

Background/aim: This study aimed to evaluate the relationship between second-and third-trimester clavicle lengths and birth weight and shoulder dystocia. Materials and methods:This prospective observational study included 181 patients who presented to the Private Etlik Lokman Hekim Hospital for routine pregnancy visits between March 2019 and March 2020. In addition to routine pregnancy examinations, the patients also underwent ultrasonography twice at weeks 20-23 and 33-36 to determine the length of the fetal clavicle. The patients were evaluated for shoulder dystocia in the second stage of labor. The birth weight of the neonates was recorded. The primary objective of this study was to establish the relationship between third-trimester clavicle length and shoulder dystocia.Results: Fetal clavicle length increases in the second trimester with the advancing gestational week but does not significantly change in the third trimester. We did not observe any significant difference for second trimester clavicle length between the type of delivery, birth weight, or shoulder dystocia. Moreover, we did not observe any significant difference for third trimester clavicle length between types of delivery. However, we found a significant relationship between third trimester clavicle length and birth weight and shoulder dystocia. The median third-trimester clavicle length was 39.5 mm (range: 30.7-43.9) in neonates who did not develop shoulder dystocia and 42.5 mm (range: 41.4-43.1) in the 3 neonates who developed shoulder dystocia. The third-trimester clavicle length cut-off for shoulder dystocia was calculated as 41.35 mm (sensitivity: 100.00%, specificity: 83.82%, accuracy: 84.5%). The third-trimester clavicle length cut-off for macrosomia (defined as birth weight of ≥4100 g) was 40.75 mm (sensitivity: 87.50%, specificity: 77.56%, accuracy: 78.05%). Conclusion:Third-trimester fetal clavicle length, an important component of biacromial diameter, as measured by ultrasonography, is a practical and significant method for predicting macrosomia and shoulder dystocia.

Accuracy of Fetal Biacromial Diameter and Derived Ultrasonographic Parameters to Predict Shoulder Dystocia: A Prospective Observational Study

“…Youssef et al evidenced the association between a new ultrasound formula (to measure the fetal biacromial diameter), fetal macrosomia and ShD, which was the starting point of our trial [27]. Similarly, Terzi et al evaluated the role of fetal clavicle length to predict ShD [44]. Their study showed a comparable diagnostic accuracy relative to BA.…”

“…Their study showed a comparable diagnostic accuracy relative to BA. However, their study was also limited by a reduced sample size [44]. In our study, the four women who experienced ShD were heterogenous, with two of them with a diagnosis of gestational diabetes mellitus.…”

Shoulder Dystocia: A Comprehensive Literature Review on Diagnosis, Prevention, Complications, Prognosis, and Management

“…The dissection of the symphysis pubis and rupture of the uterus are less commonly recorded. The incidence of the above complications does not appear to be affected by the number or type of manipulations applied to treat shoulder dystocia, except for symphysis pubis dissection and transient uterine neuralgia associated with the McRoberts manipulation mentioned below [ 51 , 52 , 53 , 54 , 55 ].…”

Usefulness of fetal sacral length measurement for the prediction of gestational age

“…Las mediciones de extremidades fetales, como la longitud del fémur (LF), permiten evaluar el crecimiento anormal y anomalías esqueléticas (6). Además, existen nomogramas de otras estructuras, como diámetro transverso del cerebelo fetal, clavícula, mandíbula, escápula, arco vertebral, hueso iliaco y pie, que también pueden utilizarse para establecer la velocidad de crecimiento fetal y calcular de la EG (7)(8)(9)(10).…”