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Anne Eskild - One of the best experts on this subject based on the ideXlab platform.
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risk of shoulder Dystocia associations with parity and offspring birthweight a population study of 1 914 544 deliveries
Acta Obstetricia et Gynecologica Scandinavica, 2012Co-Authors: Eva A Overland, Anne Eskild, Lars J VattenAbstract:Objectives. We estimated the associations of parity and offspring birthweight with the risk of shoulder Dystocia, and studied whether the association of offspring birthweight differed by parity. Design. Population-based register study. Setting. The Medical Birth Registry of Norway was used to identify all deliveries between 1967 and 2006. Population. All vaginal deliveries of a singleton offspring in cephalic presentation during the period 1967–2006 (n=1 914 544). Main outcome measure. Shoulder Dystocia at delivery. Results: Shoulder Dystocia occurred in 0.68% (13 109/1 914 544) of all deliveries. There was a strong positive association of birthweight with risk of shoulder Dystocia, and 75% (9765/13 109) of all cases occurred in deliveries of offspring weighing 4000g or more. The association of birthweight displayed similar patterns across parities, but the association was slightly stronger in parous than in primiparous women. Among first-time mothers, 0.12% (320/276 614) with offspring weighing 3000–3499g (reference) experienced shoulder Dystocia, compared with 13.30% (169/1244) with offspring birthweight higher than 5000g [odds ratio (OR) 135.7, 95%CI 111.6–165.1]. The corresponding results for women with one previous delivery were 0.08% (161/201 572) and 16.45% (501/3054) (OR 246.4, 95%CI 205.4–295.5). Conclusions. High offspring birthweight is the major risk factor for shoulder Dystocia, constituting most cases. The positive association of birthweight with shoulder Dystocia showed similar patterns across parities, but high birthweight parous women were at greater risk of shoulder Dystocia compared with primiparous women.
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risk of shoulder Dystocia in second delivery does a history of shoulder Dystocia matter
American Journal of Obstetrics and Gynecology, 2009Co-Authors: Eva A Overland, Anny Spydslaug, Anne Eskild, Christopher Sivert NielsenAbstract:OBJECTIVE: Our aim was to estimate the relative and absolute risk of shoulder Dystocia in the second delivery according to history of shoulder Dystocia and offspring birthweight. STUDY DESIGN: A retrospective cohort study including all women in Norway with 2 consecutive singleton vaginal deliveries with fetus in cephalic presentation, during the period 1967-2005 (n = 537,316). RESULTS: In the second delivery shoulder Dystocia occurred in 0.8% of all women. In women with a prior shoulder Dystocia the recurrence risk was 7.3%. Most cases of shoulder Dystocia in second delivery were in women without such history (96.2%). Offspring birthweight was the most important risk factor for shoulder Dystocia in second delivery: crude odds ratio, 292.9 (95% confidence interval, 237.8-360.7) comparing birthweight > 5000 g with 3000-3499 g. CONCLUSION: Prior shoulder Dystocia increased the risk of shoulder Dystocia in the second delivery. However, offspring birthweight was by far the most important risk factor.
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Risk of shoulder Dystocia in second delivery: does a history of shoulder Dystocia matter?
American journal of obstetrics and gynecology, 2009Co-Authors: Eva A Overland, Anny Spydslaug, Christopher Sivert Nielsen, Anne EskildAbstract:Our aim was to estimate the relative and absolute risk of shoulder Dystocia in the second delivery according to history of shoulder Dystocia and offspring birthweight. A retrospective cohort study including all women in Norway with 2 consecutive singleton vaginal deliveries with fetus in cephalic presentation, during the period 1967-2005 (n = 537,316). In the second delivery shoulder Dystocia occurred in 0.8% of all women. In women with a prior shoulder Dystocia the recurrence risk was 7.3%. Most cases of shoulder Dystocia in second delivery were in women without such history (96.2%). Offspring birthweight was the most important risk factor for shoulder Dystocia in second delivery: crude odds ratio, 292.9 (95% confidence interval, 237.8-360.7) comparing birthweight > 5000 g with 3000-3499 g. Prior shoulder Dystocia increased the risk of shoulder Dystocia in the second delivery. However, offspring birthweight was by far the most important risk factor.
Robert B. Gherman - One of the best experts on this subject based on the ideXlab platform.
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shoulder Dystocia the unpreventable obstetric emergency with empiric management guidelines
American Journal of Obstetrics and Gynecology, 2006Co-Authors: Robert B. Gherman, Joseph G. Ouzounian, Henry M Lerner, Suneet P. Chauhan, Bernard Gonik, Murphy T GoodwinAbstract:Objective Much of our understanding and knowledge of shoulder Dystocia has been blurred by inconsistent and scientific studies that are of limited scientific quality. In an evidence-based format, we sought to answer the following questions: (1) Is shoulder Dystocia predictable? (2) Can shoulder dsytocia be prevented? (3) When shoulder Dystocia does occur, what maneuvers should be performed? and (4) What are the sequelae of shoulder Dystocia? Study design Electronic databases, including PUBMED and the Cochrane Database, were searched using the key word "shoulder Dystocia." We also performed a manual review of articles included in the bibliographies of these selected articles to further define articles for review. Only those articles published in the English language were eligible for inclusion. Results There is a significantly increased risk of shoulder Dystocia as birth weight linearly increases. From a prospective point of view, however, prepregnancy and antepartum risk factors have exceedingly poor predictive value for the prediction of shoulder Dystocia. Late pregnancy ultrasound likewise displays low sensitivity, decreasing accuracy with increasing birth weight, and an overall tendency to overestimate the birth weight. Induction of labor for suspected fetal macrosomia has not been shown to alter the incidence of shoulder Dystocia among nondiabetic patients. The concept of prophylactic cesarean delivery as a means to prevent shoulder Dystocia and therefore avoid brachial plexus injury has not been supported by either clinical or theoretic data. Although many maneuvers have been described for the successful alleviation of shoulder Dystocia, there have been no randomized controlled trials or laboratory experiments that have directly compared these techniques. Despite the introduction of ancillary obstetric maneuvers, such as McRoberts maneuver and a generalized trend towards the avoidance of fundal pressure, it has been shown that the rate of shoulder-Dystocia associated brachial plexus palsy has not decreased. The simple occurrence of a shoulder Dystocia event before any iatrogenic intervention may be associated with brachial plexus injury. Conclusion For many years, long-standing opinions based solely on empiric reasoning have dictated our understanding of the detailed aspects of shoulder Dystocia prevention and management. Despite its infrequent occurrence, all healthcare providers attending pregnancies must be prepared to handle vaginal deliveries complicated by shoulder Dystocia.
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Shoulder Dystocia: Prevention and Management
Obstetrics and Gynecology Clinics of North America, 2005Co-Authors: Robert B. GhermanAbstract:: Knowledge of the maneuvers used for the alleviation of shoulder Dystocia is relevant not only for obstetric residents and attending house staff but also for family practitioners, nurses, and nurse midwives. The performance of shoulder Dystocia "drills" can be helpful not only to coordinate a teamwork approach to this obstetric emergency but also to provide an opportunity to practice the maneuvers. Shoulder Dystocia continues to represent an immense area of clinical interest because it typically occurs without prediction. All patients in labor should be considered at risk for the development of shoulder Dystocia.
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shoulder Dystocia are historic risk factors reliable predictors
American Journal of Obstetrics and Gynecology, 2005Co-Authors: Joseph G. Ouzounian, Robert B. GhermanAbstract:Objective Our purpose was to determine the rate of associated risk factors for shoulder Dystocia from a large cohort of patients delivered within our Southern California perinatal program. Study design A retrospective analysis was performed of patients delivered from January 1991 to June 2001. Patients with and without shoulder Dystocia were identified from our computer-stored perinatal database and compared. Statistical methods used included: χ2 test, t test, calculation of odds ratios, and Fisher exact test, as indicated. Results Among the 267,228 vaginal births during the study period, there were 1,686 cases of shoulder Dystocia (rate 0.6%). Rates for operative vaginal delivery, diabetes, epidural use, multiparity, and postdatism were similar among cases with and without shoulder Dystocia. The clinical triad of oxytocin use, labor induction, and birth weight greater than 4,500 g yielded a cumulative odds ratio of 23.2 (95% CI 17.3-31.0) for shoulder Dystocia, but its sensitivity and positive predictive value were only 12.4% and 3.4%, respectively. Conclusion Historic obstetric risk factors for shoulder Dystocia are not useful predictors for the event. Furthermore, although shoulder Dystocia was observed more frequently with increasing birth weight, current limitations in estimating birth weight antenatally with accuracy preclude its practical use as a reliable predictor.
Robert J. Sokol - One of the best experts on this subject based on the ideXlab platform.
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shoulder Dystocia risk factors predictability and preventability
Seminars in Perinatology, 2014Co-Authors: Shobha H Mehta, Robert J. SokolAbstract:Shoulder Dystocia remains an unpredictable obstetric emergency, striking fear in the hearts of obstetricians both novice and experienced. While outcomes that lead to permanent injury are rare, almost all obstetricians with enough years of practice have participated in a birth with a severe shoulder Dystocia and are at least aware of cases that have resulted in significant neurologic injury or even neonatal death. This is despite many years of research trying to understand the risk factors associated with it, all in an attempt primarily to characterize when the risk is high enough to avoid vaginal delivery altogether and prevent a shoulder Dystocia, whose attendant morbidities are estimated to be at a rate as high as 16–48%. The study of shoulder Dystocia remains challenging due to its generally retrospective nature, as well as dependence on proper identification and documentation. As a result, the prediction of shoulder Dystocia remains elusive, and the cost of trying to prevent one by performing a cesarean delivery remains high. While ultimately it is the injury that is the key concern, rather than the shoulder Dystocia itself, it is in the presence of an identified shoulder Dystocia that occurrence of injury is most common. The majority of shoulder Dystocia cases occur without major risk factors. Moreover, even the best antenatal predictors have a low positive predictive value. Shoulder Dystocia therefore cannot be reliably predicted, and the only preventative measure is cesarean delivery.
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accuracy of estimated fetal weight in shoulder Dystocia and neonatal birth injury
American Journal of Obstetrics and Gynecology, 2005Co-Authors: Shobha H Mehta, Sean C Blackwell, Israel Hendler, Emmanuel Bujold, Yoram Sorokin, Joel Ager, Todd Kraemer, Robert J. SokolAbstract:Objective This study was undertaken to determine whether there is any difference in the rate of error of estimated fetal weight (EFW) in cases of shoulder Dystocia compared with controls. Study design Women whose delivery was complicated by shoulder Dystocia were studied and compared with a control group matched for parity, race, labor type (spontaneous or induced), and birth weight (BW). Accuracy (%) was defined as [(EFW-BW)/BW] × 100. The primary outcome of the study was rate of EFW underestimation error 20% or greater. Results During the 5-year study period, there were 206 cases of shoulder Dystocia that met all study criteria. There was no difference in the number of patients that had EFW underestimation error 20% or greater (shoulder Dystocia 9.8% vs control 12.8%; P = .38). There was also no difference in the number of patients that had EFW underestimation error 20% or greater between shoulder Dystocia with and without injury (injury 8.3% vs no injury 7.1%; P = .79). Conclusion EFW underestimation error in cases of shoulder Dystocia is an infrequent event and does not occur more often than in deliveries without shoulder Dystocia.
Richard S Hansell - One of the best experts on this subject based on the ideXlab platform.
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Shoulder Dystocia: an analysis of risks and obstetric maneuvers.
American journal of obstetrics and gynecology, 1993Co-Authors: James J Nocon, Debra K Mckenzie, L J Thomas, Richard S HansellAbstract:The purpose of this study was to determine whether there is a risk profile for predicting or preventing shoulder Dystocia and whether any of the obstetric maneuvers to disimpact a shoulder reduce the likelihood of permanent injury. A retrospective analysis of 14,297 parturients with 12,532 vaginal deliveries and 1765 cesarean sections (12.4%) from January 1986 through June 1990 was performed. A total of 204 maternal and infant charts, related to shoulder Dystocia or neonatal injury, were reviewed in depth for age, parity, episiotomy, type of delivery, hemorrhage, maternal obesity, diabetes, weight gain, fetal weight, sex, and Apgar scores. In addition, the type of maneuver or combination thereof used to relieve the Dystocia, type of injury to the infant, and follow-up of the injury were reviewed. The 185 coded episodes of shoulder Dystocia represent 1.4% of all vaginal deliveries (12,532). There were 42 injuries recorded: 14 fractured clavicles and 28 brachial plexus injuries. An additional 19 patients, not coded for shoulder Dystocia, sustained 14 fractured clavicles and five brachial plexus injuries. All but one of the brachial plexus injuries resolved by 6 months. The occurrence of shoulder Dystocia increased in direct relationship to the birth weight and becomes significant in newborns over 4000 gm (p < 0.01). The occurrence of a previous large infant was also a significant risk factor (p < 0.01). Diabetes and midforceps delivery become significant factors only in the presence of a large fetus. Obesity, multiparity, postdate pregnancy, use of oxytocin, low forceps delivery, episiotomy, and type of anesthesia were unrelated to shoulder Dystocia. No delivery method was without injury. This study clearly indicates that most of the traditional risk factors for shoulder Dystocia have no predictive value, shoulder Dystocia itself is an unpredictable event, and infants at risk for permanent injury are virtually impossible to predict. In addition, no delivery method in shoulder Dystocia was superior to another with respect to injury. Thus no protocol should serve to substitute for clinical judgment.
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shoulder Dystocia an analysis of risks and obstetric maneuvers
American Journal of Obstetrics and Gynecology, 1993Co-Authors: James J Nocon, Debra K Mckenzie, Lisa Thomas, Richard S HansellAbstract:Objective: The purpose of this study was to determine whether there is a risk profile for predicting or preventing shoulder Dystocia and whether any of the obstetric maneuvers to disimpact a shoulder reduce the likelihood of permanent injury. Study Design: A retrospective analysis of 14.297 parturients with 12,532 vaginal deliveries and 1765 cesarean sections (12.4%) from January 1986 through June 1990 was performed. A total of 204 maternal and infant charts, related to shoulder Dystocia or neonatal injury, were reviewed in depth for age, parity, episiotomy, type of delivery, hemorrhage, maternal obesity, diabetes, weight gain, fetal weight, sex, and Apgar scores. In addition, the type of maneuver or combination thereof used to relieve the Dystocia, type of injury to the infant, and follow-up of the injury were reviewed. Results: The 185 coded episodes of shoulder Dystocia represent 1.4% of all vaginal deliveries (12,532). There were 42 injuries recorded: 14 fractured clavicles and 28 brachial plexus injuries. An additional 19 patients, not coded for shoulder Dystocia, sustained 14 fractured clavicles and five brachial plexus injuries. All but one of the brachial plexus injuries resolved by 6 months. The occurrence of shoulder Dystocia increased in direct relationship to the birth weight and becomes significant in newborns over 4000 gm ( p p Conclusions: This study clearly indicates that most of the traditional risk factors for shoulder Dystocia have no predictive value, shoulder Dystocia itself is an unpredictable event, and infants at risk for permanent injury are virtually impossible to predict. In addition, no delivery method in shoulder Dystocia was superior to another with respect to injury. Thus no protocol should serve to substitute for clinical judgment.
Eva A Overland - One of the best experts on this subject based on the ideXlab platform.
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risk of shoulder Dystocia associations with parity and offspring birthweight a population study of 1 914 544 deliveries
Acta Obstetricia et Gynecologica Scandinavica, 2012Co-Authors: Eva A Overland, Anne Eskild, Lars J VattenAbstract:Objectives. We estimated the associations of parity and offspring birthweight with the risk of shoulder Dystocia, and studied whether the association of offspring birthweight differed by parity. Design. Population-based register study. Setting. The Medical Birth Registry of Norway was used to identify all deliveries between 1967 and 2006. Population. All vaginal deliveries of a singleton offspring in cephalic presentation during the period 1967–2006 (n=1 914 544). Main outcome measure. Shoulder Dystocia at delivery. Results: Shoulder Dystocia occurred in 0.68% (13 109/1 914 544) of all deliveries. There was a strong positive association of birthweight with risk of shoulder Dystocia, and 75% (9765/13 109) of all cases occurred in deliveries of offspring weighing 4000g or more. The association of birthweight displayed similar patterns across parities, but the association was slightly stronger in parous than in primiparous women. Among first-time mothers, 0.12% (320/276 614) with offspring weighing 3000–3499g (reference) experienced shoulder Dystocia, compared with 13.30% (169/1244) with offspring birthweight higher than 5000g [odds ratio (OR) 135.7, 95%CI 111.6–165.1]. The corresponding results for women with one previous delivery were 0.08% (161/201 572) and 16.45% (501/3054) (OR 246.4, 95%CI 205.4–295.5). Conclusions. High offspring birthweight is the major risk factor for shoulder Dystocia, constituting most cases. The positive association of birthweight with shoulder Dystocia showed similar patterns across parities, but high birthweight parous women were at greater risk of shoulder Dystocia compared with primiparous women.
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risk of shoulder Dystocia in second delivery does a history of shoulder Dystocia matter
American Journal of Obstetrics and Gynecology, 2009Co-Authors: Eva A Overland, Anny Spydslaug, Anne Eskild, Christopher Sivert NielsenAbstract:OBJECTIVE: Our aim was to estimate the relative and absolute risk of shoulder Dystocia in the second delivery according to history of shoulder Dystocia and offspring birthweight. STUDY DESIGN: A retrospective cohort study including all women in Norway with 2 consecutive singleton vaginal deliveries with fetus in cephalic presentation, during the period 1967-2005 (n = 537,316). RESULTS: In the second delivery shoulder Dystocia occurred in 0.8% of all women. In women with a prior shoulder Dystocia the recurrence risk was 7.3%. Most cases of shoulder Dystocia in second delivery were in women without such history (96.2%). Offspring birthweight was the most important risk factor for shoulder Dystocia in second delivery: crude odds ratio, 292.9 (95% confidence interval, 237.8-360.7) comparing birthweight > 5000 g with 3000-3499 g. CONCLUSION: Prior shoulder Dystocia increased the risk of shoulder Dystocia in the second delivery. However, offspring birthweight was by far the most important risk factor.
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Risk of shoulder Dystocia in second delivery: does a history of shoulder Dystocia matter?
American journal of obstetrics and gynecology, 2009Co-Authors: Eva A Overland, Anny Spydslaug, Christopher Sivert Nielsen, Anne EskildAbstract:Our aim was to estimate the relative and absolute risk of shoulder Dystocia in the second delivery according to history of shoulder Dystocia and offspring birthweight. A retrospective cohort study including all women in Norway with 2 consecutive singleton vaginal deliveries with fetus in cephalic presentation, during the period 1967-2005 (n = 537,316). In the second delivery shoulder Dystocia occurred in 0.8% of all women. In women with a prior shoulder Dystocia the recurrence risk was 7.3%. Most cases of shoulder Dystocia in second delivery were in women without such history (96.2%). Offspring birthweight was the most important risk factor for shoulder Dystocia in second delivery: crude odds ratio, 292.9 (95% confidence interval, 237.8-360.7) comparing birthweight > 5000 g with 3000-3499 g. Prior shoulder Dystocia increased the risk of shoulder Dystocia in the second delivery. However, offspring birthweight was by far the most important risk factor.