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Critical analysis of risk factors for shoulder dystocia

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

The study was aimed to define trends, risk factors and perinatal outcome associated with shoulder dystocia (SD).

Methods

A population-based study comparing all singleton deliveries with and without SD was conducted. Statistical analysis was performed using multiple logistic regression analysis.

Results

Shoulder dystocia complicated 0.2% (n = 451) of all deliveries included in the study (n = 240,189). The rate of SD declined from 0.4% in 1988 to 0.13% in 2009. Independent risk factors for SD in a multivariable analysis were fetal macrosomia (birth-weight ≥ 4 kg; OR = 16.1; 95% CI 13.2–19.6, P < 0.001), failure of labor to progress during the second stage (OR = 2.4; 95% CI 1.5–3.7, P < 0.001), diabetes mellitus (OR = 1.8; 95% CI 1.4–2.3, P < 0.001) and advanced maternal age (years, OR = 1.02; 95% CI 1.001–1.03, P = 0.029). Perinatal mortality was significantly higher after SD as compared to the comparison group (6.2 vs. 1.4%, P <0.001). Another multivariable analysis, with perinatal mortality as the outcome variable, controlling for confounders such as maternal age, gestational age, diabetes mellitus, etc. was constructed; SD was noted as an independent risk factor for perinatal mortality (adjusted OR = 11.1; 95% CI 7.2–17.1, P < 0.001).

Conclusions

Shoulder dystocia, associated with macrosomia, labor dystocia, diabetes mellitus, and advanced maternal age, is an independent risk factor for perinatal mortality. In an era of increased rate of cesarean deliveries, and perhaps increased accuracy of birth weight estimation, the rate of shoulder dystocia gradually declines.

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Acknowledgments

Performed in part of Avishai Tsur MD requirements.

Conflict of interest

The authors report no conflicts of interest.

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Authors and Affiliations

  1. The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Be’er Sheva, Israel

    Avishai Tsur

  2. Department of Epidemiology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel

    Ruslan Sergienko

  3. Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, P.O. Box 151, Be’er Sheva, Israel

    Arnon Wiznitzer & Eyal Sheiner

  4. Department of Anesthesiology, Soroka University Medical Center, Ben-Gurion University of the Negev, Be’er Sheva, Israel

    Alexander Zlotnik

Authors
  1. Avishai Tsur
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  2. Ruslan Sergienko
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  3. Arnon Wiznitzer
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  4. Alexander Zlotnik
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  5. Eyal Sheiner
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Correspondence to Eyal Sheiner.

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Tsur, A., Sergienko, R., Wiznitzer, A. et al. Critical analysis of risk factors for shoulder dystocia. Arch Gynecol Obstet 285, 1225–1229 (2012). https://doi.org/10.1007/s00404-011-2139-8

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  • DOI: https://doi.org/10.1007/s00404-011-2139-8

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