Am J Perinatol 2007; 24(6): 365-371
DOI: 10.1055/s-2007-984401
Copyright © by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Shoulder Dystocia with and without Brachial Plexus Injury: Experience from Three Centers

Suneet P. Chauhan1 , Jill Cole2 , M. Ryan Laye3 , Ken Choi4 , Maureen Sanderson5 , R. Clifton Moore3 , Everett F. Magann4 , Holly L. King2 , John C. Morrison3
  • 1Aurora Health Care, West Allis, Wisconsin
  • 2Spartanburg Regional Medical Center, Spartanburg, South Carolina
  • 3University of Mississippi, Jackson, Mississippi
  • 4Naval Hospital, Portsmouth, Virginia
  • 5University of Texas School of Public Health at Brownsville, Texas
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Publikationsverlauf

Publikationsdatum:
13. Juni 2007 (online)

ABSTRACT

This article compares the maneuvers used to relieve shoulder dystocia (SD) at three centers and discerns risk factors for brachial plexus injury (BPI) following SD. Retrospectively SD managed at three tertiary centers was identified and charts reviewed. Unconditional logistic regression was used to identify risk factors for BPI. SD was encountered in 2% of vaginal deliveries (624/29,591), and BPI followed impacted shoulders in 6% (38/624). The rate of SD among the three institutes varied significantly (1.5%, 2%, 0.8% of vaginal births; p < 0.0001). The use of the McRoberts' maneuver to relieve SD differed significantly by center (98%, 80%, 90%; p < 0.0001) as did the use of suprapubic pressure (83%, 66%, 54%; p < 0.0001). The rate of BPI per case of SD (10%, 3%, 5%) was significantly different at the three centers (p = 0.009). A multivariate predictive model indicates that among those with and without concomitant fractures, there is a significantly increased risk of BPI if three or more maneuvers are used rather than two or fewer. In conclusion, not only does the rate of SD and BPI following it occur at significantly different rates, the management differs too. Compared with two maneuvers or fewer, there is an increased risk of BPI if three or more maneuvers are used to relieve SD.

REFERENCES

  • 1 American College of Obstetricians and Gynecologists .Shoulder dystocia. ACOG Practice Bulletin No. 40. Washington DC; ACOG 2002
  • 2 Chauhan S P, Rose C H, Gherman R B, Magann E F, Holland M W, Morrison J C. Brachial plexus injury: a 23-year experience from a tertiary center.  Am J Obstet Gynecol. 2005;  192 1795-1800
  • 3 Adler J B, Patterson Jr R L. Erb's palsy: Long-term results of treatment in eighty-eight cases.  J Bone Joint Surg Am. 1967;  49 1052-1064
  • 4 Dandolu V, Lawrence L, Gaughan J P et al.. Trends in the rate of shoulder dystocia over two decades.  J Matern Fetal Neonatal Med. 2005;  18 305-310
  • 5 Christoffersson M, Rydhstroem H. Shoulder dystocia and brachial plexus injury: a population-based study.  Gynecol Obstet Invest. 2002;  53 42-47
  • 6 Gherman R B, Goodwin T M, Souter I, Neumann K, Ouzounian J G, Paul R H. The McRoberts' maneuver for the alleviation of shoulder dystocia: How successful is it?.  Am J Obstet Gynecol. 1997;  176 656-661
  • 7 Gross S J, Shime J, Farine D. Shoulder dystocia: Predictors and outcome.  Am J Obstet Gynecol. 1987;  156 334-336
  • 8 American College of Obstetricians and Gynecologists .Shoulder dystocia. ACOG practice patterns No. 7. Washington DC; ACOG 1997
  • 9 Hendrix N W, Chauhan S P. Cesarean delivery for nonreassuring fetal heart rate tracing.  Obstet Gynecol Clin North Am. 2005;  32 273-286
  • 10 Perlow J H, Wigton T, Hart J, Strassner H T, Nageotte M P, Wolk B M. Birth trauma. A five-year review of incidence and associated perinatal factors.  J Reprod Med. 1996;  41 754-760
  • 11 Christoffersson M, Kannisto P, Rydhstroem H, Stale H, Walles B. Shoulder dystocia and brachial plexus injury: a case-control study.  Acta Obstet Gynecol Scand. 2003;  82(2) 147-151
  • 12 Gudmundsson S, Henningsson A C, Lindqvist P. Correlation of birth injury with maternal height and birthweight.  BJOG. 2005;  112 764-767
  • 13 Tandon S, Tandon V. Primiparity: a risk factor for brachial plexus injury in the presence of shoulder dystocia?.  J Obstet Gynaecol. 2005;  25 465-468
  • 14 Mehta S H, Blackwell S C, Bujold E, Sokol R J. What factors are associated with neonatal injury following shoulder dystocia?.  J Perinatol. 2006;  26 85-88
  • 15 Iffy L, Varadi V, Jakobovits A. Common intrapartum denominators of shoulder dystocia related birth injuries.  Zentralbl Gynakol. 1994;  116 33-37
  • 16 Mollberg M, Hagberg H, Bager B, Lilja H, Ladfors L. High birthweight and shoulder dystocia: the strongest risk factors for obstetrical brachial plexus palsy in a Swedish population-based study.  Acta Obstet Gynecol Scand. 2005;  84 654-659
  • 17 Gherman R B, Chauhan S, Oh C, Goodwin T M. Brachial plexus palsy.  Fetal Matern Med Rev. 2005;  16 221-243
  • 18 Gherman R B, Tramont J, Muffley P, Goodwin T M. Analysis of McRoberts' maneuver by x-ray pelvimetry.  Obstet Gynecol. 2000;  95 43-47
  • 19 Gherman R B, Ouzounian J G, Goodwin T M. Obstetric maneuvers for shoulder dystocia and associated fetal morbidity.  Am J Obstet Gynecol. 1998;  178 1126-1130

Suneet P ChauhanM.D. 

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