Antenatal risk score for prediction of shoulder dystocia with focus on fetal ultrasound data

Shoulder dystocia is one of the most threatening complications during delivery, and although it is difficult to predict, individual risk should be considered when counseling for mode of delivery. This study aimed to develop and validate a risk score for shoulder dystocia based on fetal ultrasound an...

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Bibliographic Details
Published in:American journal of obstetrics and gynecology 2022-11, Vol.227 (5), p.753.e1-753.e8
Main Authors: Duewel, Antonia M., Doehmen, Julia, Dittkrist, Luisa, Henrich, Wolfgang, Ramsauer, Babett, Schlembach, Dieter, Abou-Dakn, Michael, Maresh, Michael J.A., Schaefer-Graf, Ute M.
Format: Article
Language:English
Subjects:
abdominal-head circumference
Diabetes Mellitus
Dystocia - diagnostic imaging
Dystocia - epidemiology
estimated fetal weight
Female
Fetal Weight
gestational diabetes
Humans
prediction
Pregnancy
Retrospective Studies
Risk Factors
Shoulder - diagnostic imaging
shoulder dystocia
Shoulder Dystocia - epidemiology
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Summary:Shoulder dystocia is one of the most threatening complications during delivery, and although it is difficult to predict, individual risk should be considered when counseling for mode of delivery. This study aimed to develop and validate a risk score for shoulder dystocia based on fetal ultrasound and maternal data from 15,000 deliveries. Data were retrospectively obtained of deliveries in 3 tertiary centers between 2014 and 2017 for the derivation cohort and between 2018 and 2020 for the validation cohort. Inclusion criteria were singleton pregnancy, vaginal delivery in cephalic presentation at ≥37+0 weeks’ gestation, and fetal biometry data available within 2 weeks of delivery. Independent predictors were determined by multivariate regression analysis in the derivation cohort, and a score was developed on the basis of the effect of the predictors. The derivation cohort consisted of 7396 deliveries with a 0.91% rate of shoulder dystocia, and the validation cohort of 7965 deliveries with a 1.0% rate of shoulder dystocia. Among all women, 13.8% had diabetes mellitus, and 12.1% were obese (body mass index ≥30 kg/m2). Independent risk factors in the derivation cohort were: estimated fetal weight ≥4250 g (odds ratio, 4.27; P=.002), abdominal-head-circumference ≥2.5 cm (odds ratio, 3.96; P
ISSN:0002-9378
1097-6868
1097-6868
DOI:10.1016/j.ajog.2022.06.008