Fetal macrosomia as a risk factor for shoulder dystocia during vacuum extraction

Herzberg, Shmuel; Kabiri, Doron; Mordechai, Tzlil; Yahya, Rani Haj; Chill, Henry H.; Levitt, L.; Amsalem, Hagai; Ezra, Yossef

doi:10.1080/14767058.2016.1228060

Cited by 7 publications

(5 citation statements)

References 9 publications

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“…The individual recommendation should also include aspects such as the course of previous deliveries, the presence of gestational diabetes, the physical constitution and the motivation of the pregnant woman. During the birth, it should be noted that a vaginal-surgical delivery increases the risk of shoulder dystocia 11 . The descriptive data collected in this study can be used in conjunction with other studies as a basis.…”

Section: Discussionmentioning

confidence: 99%

“…In die individuelle Empfehlung sollten auch Aspekte wie eventuell vorausgegangene Geburtsverläufe, ein vorliegender Gestationsdiabetes, die körperliche Konstitution und die Motivation der Schwangeren einfließen. Während der Geburt sollte beachtet werden, dass eine vaginal-operative Entbindung das Risiko für eine Schulterdystokie erhöht 11 . Die in dieser Studie gesammelten deskriptiven Daten können in Zusammenschau mit anderen Studien als Grundlage genutzt werden.…”

Section: Diskussionunclassified

“…The other possible complications include increased postpartum bleeding and more severe birth injuries 8 , 11 . Foetal macrosomia also appears to increase the rate of stillbirths and Caesarean sections 2 .…”

Section: Introductionmentioning

confidence: 99%

“…Zu den weiteren möglichen Komplikationen zählen eine verstärkte postpartale Blutung und höhergradige Geburtsverletzungen 8 , 11 . Eine fetale Makrosomie scheint auch die Rate an Geburtsstillständen und Kaiserschnitten zu erhöhen 2 .…”

Section: Introductionunclassified

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Influence of Foetal Macrosomia on the Neonatal and Maternal Birth Outcome

Pahlitzsch

Hanne

Henrich

et al. 2019

Geburtshilfe Frauenheilkd

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Introduction Foetal macrosomia is associated with various obstetrical complications and is a common reason for inductions and primary or secondary Caesarean sections. The objective of this study is the generation of descriptive data on the mode of delivery and on maternal and foetal complications in the case of foetal macrosomia. The causes and consequences of foetal macrosomia as well as the rate of shoulder dystocia are examined in relation to the severity of the macrosomia. Patients The study investigated all singleton births ≥ 37 + 0 weeks of pregnancy with a birth weight ≥ 4000 g at the Charité University Medicine Berlin (Campus Mitte 2001 – 2017, Campus Virchow Klinikum 2014 – 2017). Results 2277 consecutive newborns (birth weight 4000 – 4499 g [88%], 4500 – 4999 g [11%], ≥ 5000 g [1%]) were included. Maternal obesity and gestational diabetes were more common in the case of newborns weighing ≥ 4500 g than newborns weighing 4000 – 4499 g (p = 0.001 and p < 0.001). Women with newborns ≥ 5000 g were more often ≥ 40 years of age (p = 0.020) and multipara (p = 0.025). The mode of delivery was spontaneous in 60% of cases, vaginal-surgical in 9%, per primary section in 14% and per secondary section in 17%. With a birth weight ≥ 4500 g, a vaginal delivery was more rare (p < 0.001) and the rate of secondary sections was increased (p = 0.011). Women with newborns ≥ 4500 g suffered increased blood loss more frequently (p = 0.029). There was no significant difference with regard to the rate of episiotomies or serious birth injuries. Shoulder dystocia occurred more frequently at a birth weight of ≥ 4500 g (5 vs. 0.9%, p = 0.000). Perinatal acidosis occurred in 2% of newborns without significant differences between the groups. Newborns ≥ 4500 g were transferred to neonatology more frequently (p < 0.001). Conclusion An increased birth weight is associated with an increased maternal risk and an increased rate of primary and secondary sections as well as shoulder dystocia; no differences in the perinatal outcome between newborns with a birth weight of 4000 – 4499 g and ≥ 4500 g were seen. In our collective, a comparably low incidence of shoulder dystocia was seen. In the literature, the frequency is indicated with a large range (1.9 – 10% at 4000 – 4499 g, 2.5 – 20% at 4500 – 5000 g and 10 – 20% at ≥ 5000 g). One possible cause for the low rate could be the equally low prevalence of gestational diabetes in our collective. A risk stratification of the pregnant women (e.g. avoidance of vacuum extraction, taking gestational diabetes into account during delivery planning) is crucial. If macrosomia is presumed, it is recommended that delivery take place at a perinatal centre in the presence of a specialist physician, due to the increased incidence of foetal and maternal complications.

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Section: Discussionmentioning

confidence: 99%

Section: Diskussionunclassified

Section: Introductionmentioning

confidence: 99%

Section: Introductionunclassified

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Influence of Foetal Macrosomia on the Neonatal and Maternal Birth Outcome

Pahlitzsch

Hanne

Henrich

et al. 2019

Geburtshilfe Frauenheilkd

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“…Increased awareness and various interventions may moderate this trend [ 5 ]; however, the percentage of fetal macrosomia is still high, in some places reaching 20% of deliveries [ 6 ]. Numerous maternal and neonatal complications have been associated with macrosomia, including low Apgar scores, shoulder dystocia, brachial plexus injuries, prolonged labor, instrumental delivery, perineal tears and postpartum hemorrhage [ 7 , 8 , 9 , 10 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Vacuum-Assisted Delivery Complication Rates Based on Ultrasound-Estimated Fetal Weight

Schreiber

Cohen

Farladansky-Gershnabel

et al. 2022

JCM

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This retrospective cohort study investigated the association between ultrasonographic estimated fetal weight (EFW) and adverse maternal and neonatal outcomes after vacuum-assisted delivery (VAD). It included women with singleton pregnancies at 34–41 weeks gestation, who underwent ultrasonographic pre-labor EFW and VAD in an academic institution, over 6 years. Adverse neonatal and maternal outcomes included shoulder dystocia, clavicular fracture, or third- and fourth-degree perineal tears. A receiver–operator characteristic curve was used to identify the optimal weight cut-off value to predict adverse outcomes. Fetuses above and below this point were compared. Multivariate analysis was used to control for factors that could lead to adverse outcomes. Eight-hundred and fifty women met the inclusion criteria and had sonographic EFW within two-weeks before delivery. Receiver–operator characteristic curve analysis found that ultrasonographic EFW 3666 g is the optimal threshold for adverse outcomes. Based on these results, outcomes were compared using EFW 3700 g. The average EFW in the ≥3700 g group (n = 220, 25.9%) was 3898 ± 154 g (average birthweight 3710 ± 324 g). In the group <3700 g (n = 630, 74.1%), average EFW was 3064 ± 411 g (birthweight 3120 ± 464 g). Shoulder dystocia and clavicular fractures were more frequent in the higher EFW group (6.4% and 2.3% vs. 1.6% and 0.5%, respectively; p < 0.05). Women in the ≥3700 g group experienced more third- and fourth-degree perineal tears (3.2% vs. 1%, p = 0.02). Multivariate logistic regression analysis found maternal age, diabetes and sonographic EFW ≥ 3700 g as independent risk-factors for adverse outcomes. Sonographic EFW ≥ 3700 g is an independent risk-factor for adverse outcomes in VAD. This should be considered when choosing the optimal mode of delivery.

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The association of vacuum-assisted delivery and shoulder dystocia among macrosomic newborns: a retrospective study

Tsur

Rottenstreich

Cahan

et al. 2021

Arch Gynecol Obstet

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Fetal macrosomia as a risk factor for shoulder dystocia during vacuum extraction

Abstract: Vacuum extraction of a macrosomic infant is a risk factor for shoulder dystocia but not for postpartum hemorrhage or severe vaginal tears.

Cited by 7 publications

References 9 publications

Influence of Foetal Macrosomia on the Neonatal and Maternal Birth Outcome

Influence of Foetal Macrosomia on the Neonatal and Maternal Birth Outcome

Vacuum-Assisted Delivery Complication Rates Based on Ultrasound-Estimated Fetal Weight

The association of vacuum-assisted delivery and shoulder dystocia among macrosomic newborns: a retrospective study

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