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

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...

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Bibliographic Details
Published in:Archives of gynecology and obstetrics 2009, Vol.279 (1), p.47-51
Main Authors: Melendez, J., Bhatia, R., Callis, L., Woolf, V., Yoong, W.
Format: Article
Language:English
Subjects:
Adult
Apgar score
Birth injuries
Birth Injuries - etiology
Birth Injuries - pathology
Brachial Plexus Neuropathies - etiology
Brachial Plexus Neuropathies - pathology
Case-Control Studies
Dystocia - pathology
Endocrinology
Female
Fetal Macrosomia
Gynecology
Health risk assessment
Human Genetics
Humans
Infant, Newborn
Medicine
Medicine & Public Health
NMR
Nuclear magnetic resonance
Obstetrics/Perinatology/Midwifery
Original Article
Pregnancy
Shoulder Injuries
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Summary: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/m 2 ) 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  
ISSN:0932-0067
1432-0711
DOI:10.1007/s00404-008-0668-6