Am J Perinatol 2014; 31(05): 401-406
DOI: 10.1055/s-0033-1350056
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Multicenter Assessment of 1,177 Cases of Shoulder Dystocia: Lessons Learned

Suneet P. Chauhan
1   Department of Obstetrics and Gynecology, Eastern Virginia Medical Center, Norfolk, Virginia
,
M. Ryan Laye
2   Department of Obstetrics and Gynecology, Spartanburg Regional Medical Center, Spartanburg, South Carolina
,
Monica Lutgendorf
3   Department of Obstetrics and Gynecology, Portsmouth Naval Hospital, Portsmouth, Virginia
,
John W. McBurney
4   Department of Obstetrics and Gynecology, Geisinger Specialty Clinic, Wilkes-Barre, Pennsylvania
,
Sharon D. Keiser
5   Department of Obstetrics and Gynecology, University of Mississippi, Jackson, Mississippi
,
Everett F. Magann
6   Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
,
John C. Morrison
5   Department of Obstetrics and Gynecology, University of Mississippi, Jackson, Mississippi
› Author Affiliations
Further Information

Publication History

08 February 2013

07 June 2013

Publication Date:
24 July 2013 (online)

Abstract

The purposes of this review were to describe deliveries complicated by shoulder dystocia (SD) at three tertiary centers and discern the differences between SD with and without brachial plexus injury (BPI). The inclusion criteria for this multicenter, retrospective study were singletons, delivered vaginally with SD. To discern the risk factors for SD with and without injury, a case (SD and BPI) versus control (3 SD without injury at the same institution) design was used. Multiple linear regression was employed. Over a 7-year period, among 46,637 vaginal deliveries, SD occurred in 1,177 cases (2.5%) and BPI was noted in 11%. The results of multiple regression indicate that gestational age, operative delivery, and the number of maneuvers and concomitant fracture (4%) were statistically associated with BPI following SD (p < 0.001). SD was not associated with BPI in 89% and 88% of the cases that were resolved with McRoberts maneuver and suprapubic pressure, whereas only 0.2% of cases were litigated.

 
  • References

  • 1 American College of Obstetricians and Gynecologists. Shoulder Dystocia. ACOG Practice Pattern No 40. Washington, DC: American College of Obstetricians and Gynecologists; 2002
  • 2 Poggi SH, Spong CY, Allen RH. Prioritizing posterior arm delivery during severe shoulder dystocia. Obstet Gynecol 2003; 101 (5 Pt 2) 1068-1072
  • 3 Poggi SH, Ghidini A, Allen RH, Pezzullo JC, Rosenbaum TC, Spong CY. Effect of operative vaginal delivery on the outcome of permanent brachial plexus injury. J Reprod Med 2003; 48 (9) 692-696
  • 4 Hope P, Breslin S, Lamont L , et al. Fatal shoulder dystocia: a review of 56 cases reported to the Confidential Enquiry into Stillbirths and Deaths in Infancy. Br J Obstet Gynaecol 1998; 105 (12) 1256-1261
  • 5 Poggi SH, Stallings SP, Ghidini A, Spong CY, Deering SH, Allen RH. Intrapartum risk factors for permanent brachial plexus injury. Am J Obstet Gynecol 2003; 189 (3) 725-729
  • 6 Chauhan SP, Cole J, Laye MR , et al. Shoulder dystocia with and without brachial plexus injury: experience from three centers. Am J Perinatol 2007; 24 (6) 365-371
  • 7 Chauhan SP, Lynn NN, Sanderson M, Humphries J, Cole JH, Scardo JA. A scoring system for detection of macrosomia and prediction of shoulder dystocia: a disappointment. J Matern Fetal Neonatal Med 2006; 19 (11) 699-705
  • 8 Chauhan SP, Rose CH, Gherman RB, Magann EF, Holland MW, Morrison JC. Brachial plexus injury: a 23-year experience from a tertiary center. Am J Obstet Gynecol 2005; 192 (6) 1795-1800 , discussion 1800–1802
  • 9 Deering S, Poggi S, Macedonia C, Gherman R, Satin AJ. Improving resident competency in the management of shoulder dystocia with simulation training. Obstet Gynecol 2004; 103 (6) 1224-1228
  • 10 Hankins GD, Clark SL. Brachial plexus palsy involving the posterior shoulder at spontaneous vaginal delivery. Am J Perinatol 1995; 12 (1) 44-45
  • 11 Sandmire H, Morrison J, Racinet C, Hankins G, Pecorari D, Gherman R. Newborn brachial plexus injuries: The twisting and extension of the fetal head as contributing causes. J Obstet Gynaecol 2008; 28 (2) 170-172
  • 12 Chauhan SP, Chauhan VB, Cowan BD, Hendrix NW, Magann EF, Morrison JC. Professional liability claims and Central Association of Obstetricians and Gynecologists members: myth versus reality. Am J Obstet Gynecol 2005; 192 (6) 1820-1826 , discussion 1826–1828
  • 13 Christoffersson M, Kannisto P, Rydhstroem H, Stale H, Walles B. Shoulder dystocia and brachial plexus injury: a case-control study. Acta Obstet Gynecol Scand 2003; 82 (2) 147-151
  • 14 Chauhan SP, Christian B, Gherman RB, Magann EF, Kaluser CK, Morrison JC. Shoulder dystocia without versus with brachial plexus injury: a case-control study. J Matern Fetal Neonatal Med 2007; 20 (4) 313-317
  • 15 Mehta SH, Blackwell SC, Bujold E, Sokol RJ. What factors are associated with neonatal injury following shoulder dystocia?. J Perinatol 2006; 26 (2) 85-88
  • 16 Dyachenko A, Ciampi A, Fahey J, Mighty H, Oppenheimer L, Hamilton EF. Prediction of risk for shoulder dystocia with neonatal injury. Am J Obstet Gynecol 2006; 195 (6) 1544-1549
  • 17 Cheng YW, Norwitz ER, Caughey AB. The relationship of fetal position and ethnicity with shoulder dystocia and birth injury. Am J Obstet Gynecol 2006; 195 (3) 856-862
  • 18 Tandon S, Tandon V. Primiparity: a risk factor for brachial plexus injury in the presence of shoulder dystocia?. J Obstet Gynaecol 2005; 25 (5) 465-468
  • 19 Gilbert WM, Nesbitt TS, Danielsen B. Associated factors in 1611 cases of brachial plexus injury. Obstet Gynecol 1999; 93 (4) 536-540
  • 20 Chauhan SP, Grobman WA, Gherman RA , et al. Suspicion and treatment of the macrosomic fetus: a review. Am J Obstet Gynecol 2005; 193 (2) 332-346
  • 21 Melamed N, Yogev Y, Meizner I , et al. Sonographic prediction of fetal macrosomia: the consequences of false diagnosis. J Ultrasound Med 2010; 29 (2) 225-230