The risk of shoulder dystocia related permanent fetal injury in relation to birth weight

Abstract Objective To examine birth weight related risks of fetal injury in connection with shoulder dystocia. Study design The investigation was based on a retrospective analysis of 316 fetal neurological injuries associated with deliveries complicated by arrest of the shoulders that occurred acros...

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Bibliographic Details
Published in:European journal of obstetrics & gynecology and reproductive biology 2008-01, Vol.136 (1), p.53-60
Main Authors: Iffy, Leslie, Brimacombe, Michael, Apuzzio, Joseph J, Varadi, Valeria, Portuondo, Nuris, Nagy, Balint
Format: Article
Language:English
Subjects:
Adolescent
Adult
Biological and medical sciences
Birth Injuries - epidemiology
Birth Injuries - etiology
Birth Injuries - mortality
Birth Weight
Brachial plexus injury
Child
Delivery. Postpartum. Lactation
Diseases of mother, fetus and pregnancy
Disorders
Dystocia - epidemiology
Erb's palsy
Female
Fetal Macrosomia
Gynecology. Andrology. Obstetrics
Humans
Infant, Newborn
Male
Medical sciences
Middle Aged
Nervous system (semeiology, syndromes)
Nervous system as a whole
Neurology
Obstetrics and Gynecology
Patient Participation
Pregnancy
Pregnancy. Fetus. Placenta
Retrospective Studies
Risk
Shoulder
Shoulder dystocia
United States - epidemiology
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Summary:Abstract Objective To examine birth weight related risks of fetal injury in connection with shoulder dystocia. Study design The investigation was based on a retrospective analysis of 316 fetal neurological injuries associated with deliveries complicated by arrest of the shoulders that occurred across the United States. Results The study revealed that the distribution of birthweights for the high risk shoulder dystocia population differs from the standard birthweight distribution. The relative difference per birthweight interval is used to adjust an assumed 1:1000 baseline risk of injury due to shoulder dystocia following vaginal deliveries. These adjusted risks show a need to consider new thresholds for elective cesarean delivery. Conclusions Current North American and British guidelines, that set 5000 g as minimum estimated fetal weight limit for elective cesarean section in non-diabetic and 4500 g for diabetic gravidas, may expose some macrosomic fetuses to a high risk of permanent neurological damage. The authors present the opinion that the mother, having been informed of the risks of vaginal versus abdominal delivery, should be allowed to play an active role in the critical management decisions.
ISSN:0301-2115
1872-7654
DOI:10.1016/j.ejogrb.2007.02.010