Skip to main content
SpringerLink
Log in

Severe shoulder dystocia leading to neonatal injury: a case control study

  • Original Article
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Background and objectives

Severe shoulder dystocia (SD) is associated with neonatal brachial plexus injuries and skeletal fractures, with the former being the commonest cause for litigation related to birth trauma. The aim of this case-control study was to evaluate risk factors for birth injuries in cases presenting with SD.

Methods

Between January 2000 and December 2006, 22 babies who sustained brachial nerve paralysis or skeletal fractures following severe SD and requiring admission to Special Care Baby Unit (SCBU) were identified. The control group (n = 22) comprised the next infant delivered who was deemed to have SD but did not suffer significant birth injuries. Antenatal, labour and postnatal data were collected and compared between the two groups.

Results

The study and control groups had similar median maternal age (28 vs. 26.5 years), gestational age at delivery (40 vs. 40 weeks) and estimated blood loss (300 vs. 225 ml) (both P > 0.05, Mann–Whitney test). Median 1 min Apgar scores (5.5 vs. 7), maternal BMI (31.34 vs. 27.19 kg/m2) and duration of second stages (53.8 vs. 49.2 min) were also statistically similar in both groups (P > 0.05). However, compared to controls, brachial nerve injuries and skeletal fractures were more likely to occur in mothers with gestational diabetes (5/22 vs. 1/22) or who had previous big babies (4/22 vs. 1/22) (both P < 0.05, Fisher’s exact test). Babies who had birth injuries were also more likely to have greater median birth weights (4.3 vs. 3.8 kg) and postnatal anthropometric measurements such as head circumference (35 vs. 34 cm) and ponderal indices (81.9 vs. 74.3 kg/m3) compared to controls.

Conclusion

In babies with SD, brachial nerve injuries and skeletal fractures are more likely to occur in those with greater birthweights but also larger length to weight ratios. In these babies, assessment of abdominal circumference and biacromial length by magnetic resonance imaging (MRI) may help predict the likelihood of severe SD, especially in mothers with identifiable risk factors. However, further research in larger controlled trials are still needed to determine their predictive value.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Acker D, Sachs B, Friedman E (1985) Risk factors for shoulder dystocia. Obstet Gynecol 66:762–768

    PubMed  CAS  Google Scholar 

  2. Mehta SH, Bujold E, Blackwell SC, Sorokin Y, Sokol RJ (2004) Is abnormal labour associated with shoulder dystocia in nulliparous women? Am J Obstet Gynecol 190(6):1604–1607, discussion 1607–1609

    Article  PubMed  Google Scholar 

  3. Christofferson M, Rydhstroem H (2002) Shoulder dystocia and brachial plexus injury: a population-based study. Gynecol Obstet Invest 53(1):42–47

    Article  Google Scholar 

  4. Mehta SH, Blackwell SC, Bujold E, Sokol RJ (2006) What factors are associated with neonatal injury following shoulder dystocia? J Perinatol 26(2):85–88

    Article  PubMed  CAS  Google Scholar 

  5. Cederqren MI (2004) Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 103(2):219–224

    Google Scholar 

  6. Jazayeri A, Heffron JA, Phillips R, Spellacy W (1999) Macrosomia prediction using ultrasound foetal abdominal circumference of 35 cm or more. Obstet Gynecol 93:523–526

    Article  PubMed  CAS  Google Scholar 

  7. Olugbile A, Mascarenhas L (2000) Review of Shoulder dystocia at the Birmingham Women’s Hospital. J Obstet Gynaecol 20(3):267–270

    Article  PubMed  CAS  Google Scholar 

  8. Royal College of Obstetricians and Gynaecologists Guideline 42. Shoulder dystocia. December 2005

  9. Gherman RIB, Ouzounian JG, Satin AJ, Goodwin TM, Phelan JP (2003) A comparison of shoulder dystocia-associated transient and permanent brachial plexus palsies. Obstet Gynecol 102(3):544–548

    Article  PubMed  Google Scholar 

  10. Baskett TF, Allen AC (1995) Perinatal implications of shoulder dystocia. Obstet Gynecol 177:1462–1464

    Google Scholar 

  11. Rouse DJ, Owen J, Goldenberg RL, Cliver SP (1996) The effectiveness and costs of elective Caesarean delivery for foetal macrosomia diagnosed by ultrasound. JAMA 276(18):1480–1486

    Article  PubMed  CAS  Google Scholar 

  12. Ott WJ, Doyle S (1984) Ultrasound diagnosis of altered fetal growth by use of normal ultrasound fetal weight curve. Obstet Gynecol 63:201–208

    PubMed  CAS  Google Scholar 

  13. Sandmire HF, DeMott RK (2002) Erb’s Palsy without shoulder dystocia. Int J Gynecol Obstet 78:253–256

    Article  CAS  Google Scholar 

  14. Gherman RB, Goodwin TM, Ouzounian JG, Miller DA, Paul RH (1997) Brachial plexus palsy associated with cesarean section: an in utero injury? Am J Obstet Gynecol 177:1162–1164

    Article  PubMed  CAS  Google Scholar 

  15. Lehingue Y, Remontet L, Munoz F, Marnelle N (1998) Birth ponderal index and body mass index reference curves in a large population. Am J Human Biol 10(3):327–340

    Article  Google Scholar 

  16. Christoffersson M, Kannisto P, Rydhstroem H, Stale H, Walles B (2003) Shoulder dystocia and brachial plexus injury: a case-control study. Acta Scand Gynecol Obstet 82(2):147–151

    Article  Google Scholar 

  17. O’Leary JA (1992) Shoulder dystocia and birth injury. Prevention and treatment, 1st edn. McGraw-Hill Inc., New York, pp 1–7

    Google Scholar 

  18. Kitzmiller JL, Mall JC, Gin GD, Hendricks SK, Newman RB, Scheerer L (1987) Measurement of foetal shoulder width with computed tomography in diabetic women. Obstet Gynecol 70(6):941–945

    PubMed  CAS  Google Scholar 

  19. Kastler B, Gangi A, Mathelin C, Germain P, Arhan JM, Treisser A, Dietemann JL, Wackenheim A (1993) Foetal shoulder measurements with MRI. J Comput Assist Tomogr 17(5):777–780

    Article  PubMed  CAS  Google Scholar 

  20. O’Leary JA (1992) Shoulder dystocia and birth injury. Prevention and treatment, 1st edn. McGraw-Hill Inc., New York, pp 25–40

    Google Scholar 

  21. Zuspan F, Quilligan E (1988) Douglas-Stromme Operative Obstetrics, 5th edn. Norwall, Appleton and Lange

    Google Scholar 

  22. Crofts JF, Bartlett C, Ellis D, Hunt LP, Fox R, Draycott T (2006) Training for shoulder dystocia: a trial of simulation using low-fidelity and high-fidelity mannequins. Obstet Gynecol 108:1477–1485

    PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank Mr A Fakokunde for his support during the initial part of the study. JM designed the methodology, collected and then analysed the data; in addition he performed the literature search and co-wrote the manuscript. RB and LC did additional literature searches and co-wrote the manuscript. VW helped with the methodology and co-wrote the manuscript. WY initiated the study, designed the methodology and co-wrote the manuscript.

Conflict of interest

The authors declare that they have no competing interests.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, North Middlesex University Hospital, Sterling Way, London, N18 1QX, UK

    J. Melendez & W. Yoong

  2. Royal Free and University College Medical School, London, NW3 4JP, UK

    R. Bhatia & L. Callis

  3. Division of Department of Orthopaedics, North Middlesex University Hospital, Sterling Way, London, N18 1QX, UK

    V. Woolf

Authors
  1. J. Melendez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Bhatia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Callis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. V. Woolf
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W. Yoong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W. Yoong.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Melendez, J., Bhatia, R., Callis, L. et al. Severe shoulder dystocia leading to neonatal injury: a case control study. Arch Gynecol Obstet 279, 47–51 (2009). https://doi.org/10.1007/s00404-008-0668-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-008-0668-6

Keywords

Search

Navigation