Recurrent Shoulder Dystocia: Analysis of Incidence and Risk Factors

Abstract

Objectives To determine the rate and associated risk factors for recurrent shoulder dystocia (SD).

Study design A retrospective analysis was performed of patients delivered from January 1991 to June 2001. Patients with and without recurrent SD were identified and compared.

Results Among the 267,228 vaginal births during the study period, there were 1904 cases of SD (0.7%) and 270 patients with one additional vaginal birth. The recurrent SD rate was higher than the general population (3.7% versus 0.7%, odds ratio 7.36, 95% confidence interval 3.68 to 14.23, p < 0.001). Patients with recurrent SD had a slightly higher mean birth weight with the second delivery, but this difference was not statistically significant (4173 ± 544 g versus 4017 ± 577 g, p = 0.39).

Conclusion Prior SD is a risk factor for recurrence in a subsequent delivery, but our results demonstrate that the rate appears to be lower than previously estimated. Most variables, including birth weight, do not appear to be useful parameters in predicting recurrence.

Keywords

shoulder dystocia - risk factors - obstetric emergency

• References

• 1 Gherman RB. Shoulder dystocia: an evidence-based evaluation of the obstetric nightmare. Clin Obstet Gynecol 2002; 45: 345-362
• 2 Ouzounian JG, Gherman RB. Shoulder dystocia: are historic risk factors reliable predictors?. Am J Obstet Gynecol 2005; 192: 1933-1935 ; discussion 1935–1938
• 3 Gherman RB, Chauhan S, Ouzounian JG, Lerner H, Gonik B, Goodwin TM. Shoulder dystocia: the unpreventable obstetric emergency with empiric management guidelines. Am J Obstet Gynecol 2006; 195: 657-672
• 4 Ouzounian JG, Goodwin TM. Shoulder dystocia. In: Goodwin TM, Montoro M, Muderspach L, et al, eds. Management of Common Problems in Obstetrics and Gynecology. West Sussex, England: Wiley-Blackwell Scientific Publishing; 2010
• 5 Baskett TF, Allen AC. Perinatal implications of shoulder dystocia. Obstet Gynecol 1995; 86: 14-17
• 6 Ouzounian JG, Goodwin TM. Diagnosis and management of macrosomia. In: Goodwin TM, Montoro M, Muderspach L, et al, eds. Management of Common Problems in Ob/Gyn. West Sussex, England: Wiley-Blackwell Scientific Publishing; 2010
• 7 Usta IM, Hayek S, Yahya F, Abu-Musa A, Nassar AH. Shoulder dystocia: what is the risk of recurrence?. Acta Obstet Gynecol Scand 2008; 87: 992-997
• 8 Ginsberg NA, Moisidis C. How to predict recurrent shoulder dystocia. Am J Obstet Gynecol 2001; 184: 1427-1429 ; discussion 1429–1430
• 9 Overland EA, Spydslaug A, Nielsen CS, Eskild A. Risk of shoulder dystocia in second delivery: does a history of shoulder dystocia matter?. Am J Obstet Gynecol 2009; 200: 506 , e1–e6
• 10 Smith RB, Lane C, Pearson JF. Shoulder dystocia: what happens at the next delivery?. Br J Obstet Gynaecol 1994; 101: 713-715
• 11 Lewis DF, Raymond RC, Perkins MB, Brooks GG, Heymann AR. Recurrence rate of shoulder dystocia. Am J Obstet Gynecol 1995; 172: 1369-1371
• 12 Ouzounian JG, Korst LM, Phelan JP. Permanent Erb's palsy: a lack of a relationship with obstetrical risk factors. Am J Perinatol 1998; 15: 221-223
• 13 Gherman RB, Goodwin TM, Ouzounian JG, Miller DA, Paul RH. Brachial plexus palsy associated with cesarean section: an in utero injury?. Am J Obstet Gynecol 1997; 177: 1162-1164