Determining factors associated with shoulder dystocia: a population-based study

Eyal Sheiner, Amalia Levy, Reli Hershkovitz, Mordechai Hallak, Rachel D. Hammel, Miriam Katz, Moshe Mazor

Research output: Contribution to journalArticlepeer-review

44 Scopus citations

Abstract

Objective: The study was aimed to define obstetric factors associated with shoulder dystocia. Methods: A population-based study comparing all singleton, vertex, term deliveries with shoulder dystocia with deliveries without shoulder dystocia was performed. Statistical analysis was done using multiple logistic regression analysis. Results: Shoulder dystocia complicated 0.2% (n = 245) of all deliveries included in the study (n = 107965). Independent risk factors for shoulder dystocia in a multivariable analysis were birth-weight ≥4000 g (OR = 24.3; 95% CI 18.5-31.8), vacuum delivery (OR = 5.7, 95% CI 3.4-9.5), diabetes mellitus (OR = 1.7, 95% CI 1.2-2.5) and lack of prenatal care (OR = 1.5, 95% CI 1.1-2.3). A significant linear association was found between birth-weight and shoulder dystocia, using the Mantel-Haenszel procedure. Pregnancies complicated with shoulder dystocia had higher rates of third-degree perineal tears as compared to the comparison group (0.8% versus 0.1%; P < 0.001). Similarly, perinatal mortality was higher among newborns delivered after shoulder dystocia as compared to the comparison group (3.7% versus 0.5%; OR = 7.4, 95% CI 3.5-14.9, P < 0.001). In addition, these newborns had higher rates of Apgar scores lower than 7 at 1 and 5 min as compared to newborns delivered without shoulder dystocia (29.7% versus 3.0%; OR = 13.8, 95% CI 10.3-18.4, P < 0.001 and 2.1% versus 0.3%; OR = 7.2, 95% CI 2.8-18.1, P < 0.001, respectively). Combining risk factors such as large for gestational age, diabetes mellitus and vacuum delivery increased the risk for shoulder dystocia to 6.8% (OR = 32.6, 95% CI 10.1-105.8, P < 0.001). Conclusions: Independent factors associated with shoulder dystocia were birth-weight ≥4000 g, vacuum delivery, diabetes mellitus and lack of prenatal care.

Original languageEnglish
Pages (from-to)11-15
Number of pages5
JournalEuropean Journal of Obstetrics, Gynecology and Reproductive Biology
Volume126
Issue number1
DOIs
StatePublished - 1 May 2006
Externally publishedYes

Keywords

  • Birth-weight ≥4000 g
  • Gestational diabetes
  • Shoulder dystocia
  • Vacuum delivery

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

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