Document Detail


Shoulder dystocia: are historic risk factors reliable predictors?
MedLine Citation:
PMID:  15970854     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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: chi 2 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.
Authors:
Joseph G Ouzounian; Robert B Gherman
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  192     ISSN:  0002-9378     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2005 Jun 
Date Detail:
Created Date:  2005-06-22     Completed Date:  2005-07-25     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1933-5; discussion 1935-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Kaiser Permanente Medical Center, Baldwin Park, CA 91706, USA. Joseph.G.Ouzounian@kp.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Brachial Plexus / injuries*
California / epidemiology
Cohort Studies
Databases, Factual
Dystocia / epidemiology*,  etiology
Female
Humans
Infant, Newborn
Medical Records
Predictive Value of Tests
Pregnancy
Prenatal Diagnosis*
Retrospective Studies
Risk Factors
Sensitivity and Specificity

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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