Risk Factors for Shoulder Dystocia in the Average-Weight Infant

Acker, David; Sachs, Benjamin P.; Friedman, Emanuel A.

doi:10.1097/00006250-198605000-00002

Cited by 113 publications

(69 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…OBPP occasionally occurs in infants weighing <2500 g (68). The most significant combined maternal and infant risk factors referred to in the literature are neonatal macrosomia and shoulder dystocia (9,12,(69)(70)(71).…”

Section: Risk Factorsmentioning

confidence: 99%

High birthweight and shoulder dystocia: the strongest risk factors for obstetrical brachial plexus palsy in a Swedish population‐based study

Mollberg

Hagberg

Bager

et al. 2005

Acta Obstet Gynecol Scand

137

View full text Add to dashboard Cite

Background: Obstetric brachial plexus palsy (OBPP) at birth is one important cause of neurological disability in children and adults; the incidence has increased substantially in Sweden over the past decade. Several risk factors for OBPP have been identified, e.g. high birth weight and shoulder dystocia, but it remains difficult to predict based on antenatally available information. Despite extensive research on OBPP, there is no generally accepted strategy for prevention. The overall objective of this thesis is to study predisposing risk factors for OBPP in vaginally delivered infants and to identify specific obstetric procedures that are strongly associated with OBPP. Based on this knowledge, our ultimate aim is to develop a prevention strategy with respect to manual assistance in the second stage of labour. Methods: Paper I reports on a retrospective case-control study aimed at investigation of the incidence and risk factors for OBPP in a large population studied in 1987-1997. All deliveries recorded in the Swedish Medical Birth Register during the period were investigated. Cases of OBPP were compared with all cases without OBPP. Paper II describes a retrospective casecontrol study, the purpose of which was to identify risk factors for OBPP, specifically in women delivered by vacuum extraction. The groups with and without OBPP were compared with regard to possible risk factors, including those linked to the vacuum extraction procedure. The aim of the prospective population-based case-control study presented in Paper III was to evaluate the association between OBPP and obstetric manoeuvres during the second stage of delivery. Obstetric management in OBPP cases was compared to management in a randomly selected control group. Paper IV and Paper III are based on the same cases. The aims of the study presented in Paper IV were a) to describe neurological deficits in children with remaining OBPP at 18 months of age; b) to compare maternal, infant and obstetric data in infants with and without OBPP at 18 months of age and c) to evaluate if differences in force applied in downward traction of the head (ranked on a 100-point visual analogue scale) correlated to the number of affected nerve roots (C5-C6, C5-C7, C5-Th1). Results:The incidence of OBPP in Sweden increased from 0.17% to 0.27% between 1987 and 1997. Infants with high birth weight, especially >4500 g, were at increased risk of shoulder dystocia and OBPP. However, high birth weight was not or only weakly overrepresented among children with persistent OBPP, compared with those who recovered, suggesting that other factors are important. Hence, many factors related to prolonged second stage and difficulties in delivering the shoulders were overrepresented in the OBPP group, compared to controls. In particular, forceful downward traction applied to the head after the fetal third rotation represented an important risk factor for OBPP in cephalic-presentation vaginal deliveries. Downward traction of the head had been applied more often and with greater force in the...

show abstract

Section: Risk Factorsmentioning

confidence: 99%

High birthweight and shoulder dystocia: the strongest risk factors for obstetrical brachial plexus palsy in a Swedish population‐based study

Mollberg

Hagberg

Bager

et al. 2005

Acta Obstet Gynecol Scand

137

View full text Add to dashboard Cite

show abstract

“…[4][5][6][7] In turn, fetal macrosomia has been associated with an increased risk of shoulder dystocia, fetal injury, depressed 5-min Apgar scores, and admission to the neonatal intensive care unit. 3,8,9 Potential long-term adverse health outcomes associated with fetal macrosomia include obesity and carbohydrate intolerance. 10,11 A recent, prospective randomized control trial by Crowther et al 12 suggests that treatment of gestational diabetes reduces the risk of macrosomia, shoulder dystocia and serious perinatal morbidity.…”

Section: Introductionmentioning

confidence: 99%

Role of patient education level in predicting macrosomia among women with gestational diabetes mellitus

et al. 2006

View full text Add to dashboard Cite

Objective: To evaluate the role of education level in predicting the risk of macrosomia among women with gestational diabetes mellitus.Study design: Women with gestational diabetes, who were referred to the California Diabetes and Pregnancy Sweet Success Program between June 2001 and December 2002, were included in the study. Multiple logistic regression was used estimate the risk of macrosomia, defined as a birth weight >4000 g. Results:Compared to college-educated women, high school-and middle school-educated women were 21% (relative risk (RR), 1.21; 95% confidence intervals (CI), 1.01-1.44) and 35% (RR, 1.35; 95% CI, 1.09-1.70) more likely to deliver a macrosomic infant, respectively.Conclusion: Gestational diabetics with a lower level of educational attainment appear to have an increased risk of macrosomia. Future studies are necessary to determine whether this finding reflects a variation in adherence to recommended treatments by education/literacy level, or if it is a surrogate marker for intrinsic, biological differences or differences in lifestyle.

show abstract

“…It is well established that a higher birthweight results in a higher risk of shoulder dystociarelated OBPL. 1,[15][16][17][18]27,28 In a case-control study, with birthweight as control variable, no additional risk factors could be identified for the occurrence of an OBPL. 29 So on first level, to analyse the relationship between birthweight and OBPL, it is well established that increasing birthweight leads to a higher risk of an OBPL.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] From a paediatric perspective, microsurgical papers on obstetric brachial plexus lesion (OBPL) focus solely on permanent lesions, on indication and timing for surgery and on treatment outcome. [5][6][7][8][9][10][11] Only seldom are obstetric data combined with the intraoperative pathological findings of the nerve lesion or the neurological severity of the injury.…”

Section: Introductionmentioning

confidence: 99%

Correlating birthweight with neurological severity of obstetric brachial plexus lesions

Pondaag

Allen

Malessy

2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

View full text Add to dashboard Cite

Objective To investigate the nature and extent of neurosurgically treated obstetric plexus lesions with obstetric and neonatal precedents.Design Retrospective analysis of prospectively collected data.Setting Leiden, the Netherlands.Population A 9-year cohort of infants (n = 206) neurosurgically treated for obstetric brachial plexus lesion at a tertiary referral centre for nerve lesions.Method Obstetric and neonatal data (parity, diabetic status, pregnancy gestation, mode of cephalic delivery and birthweight) were collected using a standardised protocol and correlated to neurological severity of the brachial plexus lesion.Main outcome measure Neurological severity of the brachial plexus lesion.Results Nulliparous women delivered significantly lower birthweight newborns (P = 0.016), injuries in those infants were associated with the least severe injury classification. The most prominent association in ordinal logistic regression was between neurological injury severity and larger birthweight (P < 0.001).Conclusions Birthweight is correlated with neurological severity of the injury in a group of infants experiencing brachial plexus injury resulting from cephalic vaginal delivery.Keywords Birthweight, complete brachial plexus injury, Erb's palsy, obstetric brachial plexus lesion, permanent birth injury, shoulder dystocia.Please cite this paper as: Pondaag W, Allen R, Malessy M. Correlating birthweight with neurological severity of obstetric brachial plexus lesions. BJOG

show abstract

Risk Factors for Shoulder Dystocia in the Average-Weight Infant

Cited by 113 publications

References 0 publications

High birthweight and shoulder dystocia: the strongest risk factors for obstetrical brachial plexus palsy in a Swedish population‐based study

High birthweight and shoulder dystocia: the strongest risk factors for obstetrical brachial plexus palsy in a Swedish population‐based study

Role of patient education level in predicting macrosomia among women with gestational diabetes mellitus

Correlating birthweight with neurological severity of obstetric brachial plexus lesions

Contact Info

Product

Resources

About