Antenatal risk prediction of shoulder dystocia: influence of diabetes and obesity: a multicenter study

• Published in: Archives of gynecology and obstetrics 2021-11, Vol.304 (5), p.1169-1177
• Main Authors: Vetterlein, Julia, Doehmen, Cornelius A. E., Voss, Holger, Dittkrist, Luisa, Klapp, Christine, Henrich, Wolfgang, Ramsauer, Babett, Schlembach, Dietmar, Abou-Dakn, Michael, Maresh, Michael J. A., Schaefer-Graf, Ute M.
• Format: Article
• Language: English
• Subjects: Childbirth & labor; Diabetes; Endocrinology; Gynecology; Human Genetics; Induced labor; Maternal-Fetal Medicine; Medicine; Medicine & Public Health; Obesity; Obstetrics/Perinatology/Midwifery; Risk factors; Shoulder; Ultrasonic imaging
• ISSN: 0932-0067; 1432-0711
• DOI: 10.1007/s00404-021-06041-7

Purpose To estimate the risk of shoulder dystocia (SD) in pregnancies with/without maternal diabetes or obesity; to identify antenatal maternal and fetal ultrasound-derived risk factors and calculate their contributions. Methods A multicenter retrospective analysis of 13,428 deliveries in three tertiary hospitals (2014–2017) with fetal ultrasound data ≤ 14 days prior to delivery ( n  = 7396). Inclusion criteria: singleton pregnancies in women ≥ 18 years old; vertex presentation; vaginal delivery at ≥ 37 weeks of gestation. Estimated fetal weight (EFW) and birth weight (BW) were categorized by steps of 250 g. To evaluate risk factors, a model was performed using ultrasound data with SD as the dependent variable. Results Diabetes was present in 9.3%; BMI ≥ 30 kg/m 2 in 10.4% and excessive weight gain in 39.8%. The total SD rate was 0.9%, with diabetes 2.0% and with obesity 1.9%. These increased with BW 4250–4499 g compared to 4000–4249 g in women with diabetes (12.1% vs 1.9%, P  = 0.010) and without (6.1% vs 1.6%, P