Population-Based Risk Factors for Shoulder Dystocia

Santos, Palmira; Hefele, Jennifer Gaudet; Ritter, Grant; Darden, Jennifer; Firneno, Cassandra; Hendrich, Ann

doi:10.1016/j.jogn.2017.11.011

Cited by 17 publications

(4 citation statements)

References 44 publications

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“…Concerning the 2 shoulder dystocia cases recorded, both were without any neonatal consequence, neonatal birthweights exceeded 4000 g, and none of their mothers had diabetes mellitus. Although the shoulder dystocia rate in women undergoing EA is similar to literature findings, 46 , 47 our data seem inconsistent, considering the size of our population.…”

Section: Discussioncontrasting

confidence: 46%

The impact of epidural analgesia on delivery mode in Robson class 1 women: a retrospective cohort study

Ambrosetti¹,

Grandi²,

PETRELLA³

et al. 2023

AJOG Global Reports

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Section: Discussioncontrasting

confidence: 46%

The impact of epidural analgesia on delivery mode in Robson class 1 women: a retrospective cohort study

Ambrosetti¹,

Grandi²,

PETRELLA³

et al. 2023

AJOG Global Reports

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“…The association between SD and maternal epidural use could potentially represent a type-II error, however, it has been repetitively reported. 42 43 It is conceivable that the effect of epidural anesthesia on maternal pelvic floor muscle relaxation may impact the cardinal movements associated with normal fetal descent in the second stage of labor. That effect, along with the shape and type of the maternal pelvis, likely contributed to the elusiveness of predicting SD using ultrasound measures of fetal biometry.…”

Section: Discussionmentioning

confidence: 99%

Fetal Growth Biometry as Predictors of Shoulder Dystocia in a Low-Risk Obstetrical Population

et al. 2022

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Objective: To evaluate fetal biometrics as predictors of shoulder dystocia in a low-risk obstetrical population. Study Design: Participants were enrolled as part of a U.S.-based prospective cohort study of fetal growth in low-risk singleton gestations (n=2,802). Eligible women had liveborn singletons ≥2500g delivered vaginally. Sociodemographic, anthropometric, and pregnancy outcome data were abstracted by research staff. The diagnosis of shoulder dystocia was based on the recorded clinical impression of the delivering physician. Simple logistic regression models were used to examine associations between fetal biometrics and shoulder dystocia. Fetal biometric cut points, selected by Youden’s J and clinical determination, were identified to optimize predictive capability. A final model for shoulder dystocia prediction was constructed using backward selection. Our dataset was randomly divided into training (60%) and test (40%) datasets for model building and internal validation. Results: 1691 women (98.7%) had an uncomplicated vaginal delivery while 23 (1.3%) experienced shoulder dystocia. There were no differences in sociodemographic or maternal anthropometrics between groups. Epidural anesthesia use was significantly more common (100% vs 82.4%; p=0.03) among women who experienced shoulder dystocia compared to those who did not. Several fetal biometric measures were significantly associated with shoulder dystocia when dichotomized based on clinically selected cut-points. A final prediction model was internally valid with an area under the curve of 0.90 (95% Confidence Interval 0.81- 0.99). At a model probability of 1%, sensitivity (71.4%), specificity (77.5%), positive (3.5%), and negative predictive values (99.6%) did not indicate the ability of the model to predict shoulder dystocia in a clinically meaningful way. Conclusion: Other than epidural anesthesia use, neither sociodemographic nor maternal anthropometrics were significantly associated with shoulder dystocia in this low-risk population. Both individually and in combination, fetal biometrics had limited ability to predict shoulder dystocia and lack clinical usefulness

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“…Shoulder dystocia was reported at a much higher incidence than the population average [54]. The known risk factors are maternal diabetes, body mass index over 25, age over 40, gestational age after 40 weeks, instrumental vaginal birth [54] and epidural, although its occurrence is still often unpredictable [73]. These findings indicate that hEDS/HSD may be another risk factor to consider and is therefore recommended to be considered in the next revisions of the guidance on shoulder dystocia [74].…”

Section: Discussionmentioning

confidence: 99%

Childbearing with Hypermobile Ehlers–Danlos Syndrome and Hypermobility Spectrum Disorders: A Large International Survey of Outcomes and Complications

Pearce,

Bell,

Pezaro

et al. 2023

IJERPH

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One in 20 births could be affected by hypermobile Ehlers–Danlos syndrome or Hypermobility Spectrum Disorders (hEDS/HSD); however, these are under-diagnosed and lacking research. This study aimed to examine outcomes and complications in people childbearing with hEDS/HSD. A large online international survey was completed by women with experience in childbearing and a diagnosis of hEDS/HSD (N = 947, total pregnancies = 1338). Data were collected on demographics, pregnancy and birth outcomes and complications. Participants reported pregnancies in the UK (N = 771), USA (N = 364), Australia (N = 106), Canada (N = 60), New Zealand (N = 23) and Ireland (N = 14). Incidences were higher in people with hEDS/HSD than typically found in the general population for pre-eclampsia, eclampsia, pre-term rupture of membranes, pre-term birth, antepartum haemorrhage, postpartum haemorrhage, hyperemesis gravidarum, shoulder dystocia, caesarean wound infection, postpartum psychosis, post-traumatic stress disorder, precipitate labour and being born before arrival at place of birth. This potential for increased risk related to maternal and neonatal outcomes and complications highlights the importance of diagnosis and appropriate care considerations for childbearing people with hEDS/HSD. Recommendations include updating healthcare guidance to include awareness of these possible complications and outcomes and including hEDS/HSD in initial screening questionnaires of perinatal care to ensure appropriate consultation and monitoring can take place from the start.

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Population-Based Risk Factors for Shoulder Dystocia

Abstract: With the changing characteristics of pregnant women, labor and birth clinicians care for more pregnant women who have an increased risk for shoulder dystocia. Our findings may help prospectively identify women with the greatest risk.

Cited by 17 publications

References 44 publications

The impact of epidural analgesia on delivery mode in Robson class 1 women: a retrospective cohort study

The impact of epidural analgesia on delivery mode in Robson class 1 women: a retrospective cohort study

Fetal Growth Biometry as Predictors of Shoulder Dystocia in a Low-Risk Obstetrical Population

Childbearing with Hypermobile Ehlers–Danlos Syndrome and Hypermobility Spectrum Disorders: A Large International Survey of Outcomes and Complications

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