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Shoulder dystocia related fetal neurological injuries: the predisposing roles of forceps and ventouse extractions

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Abstract

On the basis of 333 documented cases of permanent perinatal neurological damage, associated with arrest of the shoulders at birth, the authors conducted a retrospective study in order to evaluate the predisposing role, if any, of the utilization of extraction instruments. The investigation revealed that 35% of all injuries occurred in neonates delivered by forceps, ventouse or sequential ventouse–forceps procedures. This frequency was several-fold higher than the prevailing instrument use in the practices of American obstetricians during the same years. A high rate of forceps and ventouse extractions was demonstrable in all birth weight categories. Average weight and moderately large for gestational age fetuses underwent instrumental extractions more often than grossly macrosomic ones. This circumstance indicates that forceps and ventouse are independent risk factors, unrelated to fetal size. Their use entailed central nervous system injuries significantly more often than did spontaneous deliveries. The findings suggest that extraction procedures may be as important as macrosomia among the factors that lead to neurological damage in the child in connection with shoulder dystocia. Because they augment the intrinsic dangers of excessive fetal size exponentially, the authors consider their use in case of ≥4,000 g estimated fetal weight inadvisable. Sequential forceps–ventouse utilization further doubles the risks and is, therefore, to be avoided in all circumstances.

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Authors and Affiliations

  1. Department of Preventive Medicine, UMDNJ, New Jersey Medical School, Newark, NJ, USA

    Michael Brimacombe

  2. Department of Obstetrics and Gynecology, UMDNJ, New Jersey Medical School, Newark, NJ, USA

    Leslie Iffy, Joseph J. Apuzzio & Vijaya Raju

  3. Department of Pediatrics, Division of Neonatology, St Margit Hospital, Budapest, Hungary

    Valeria Varadi

  4. 1st Department of Obstetrics and Gynaecology, Semmelweis University, School of Medicine, Budapest, Hungary

    Balint Nagy

  5. The Law Firm of Schwartz, Simon, Edelstein, Celso & Kessler, Morristown, NJ, USA

    Nuris Portuondo

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  1. Michael Brimacombe
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  2. Leslie Iffy
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  4. Valeria Varadi
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  5. Balint Nagy
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  7. Nuris Portuondo
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Correspondence to Leslie Iffy.

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Brimacombe, M., Iffy, L., Apuzzio, J.J. et al. Shoulder dystocia related fetal neurological injuries: the predisposing roles of forceps and ventouse extractions. Arch Gynecol Obstet 277, 415–422 (2008). https://doi.org/10.1007/s00404-007-0465-7

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  • DOI: https://doi.org/10.1007/s00404-007-0465-7

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