Epidemiologic aspects of shoulder dystocia-related neurological birth injuries

Abstract

Incidents of shoulder dystocia began to escalate in the USA during the 1980s, shortly after the introduction of "active management" of the birthing process. This new technique replaced a conservative philosophy which had recommended abstinence from intervention on the part of the accoucheur. The authors consider the interventionist approach largely responsible for the exponential increase in the rates of shoulder dystocia in the USA. They recommend adherence to the traditional method of delivery on the part of obstetricians in Europe and elsewhere.

Singleton Vaginal Breech Delivery at Term: Maternal and Perinatal Outcome

“…Proper selection of cases with strict intrapartum monitoring minimized neonatal complications. Regarding birth trauma risks to babies in vaginal breech delivery, studies 35,36 have shown that absolute risk of birth trauma is comparable to birth trauma in cephalic vaginal deliveries who had shoulder dystocia or instrumental delivery.…”

Prevention of Brachial Plexus Injuries at Birth

“…A computer search for relevant data found that at the turn of the century in 15 medical centers of 11 countries located in four continents (listed later in this review) the incidence of shoulder dystocia had been about 0.5%. At the same time its rate was three-times as high in the USA [15]. Thus the factor or factors that multiplied the incidents of arrest of the shoulders in the USA had not been operative elsewhere.…”

“…The damaging effect of traction on the brachial plexus has been confirmed experimentally both on dead and live fetuses 3. Contrary to the American experience, in the British Islands the incidence of arrest of the shoulders remained at the range of 0.2% -0.5% throughout the last five decades [14,15,18,19].…”

“…The incidence of arrest of the shoulders at birth was less than 0.5% in the USA in the 1950's [15]. The transformation of "obstetrics" into "perinatology" that began at about that time entailed profound changes in practice patterns.…”

“…This trend necessitated the opening of neurological centers specializing in the repair of congenital brachial plexus injuries during the last decades throughout the United States [15].…”