Shoulder dystocia: Predictors and outcome

Gross, Susan J.; Shime, J.; Farine, Dan

doi:10.1016/0002-9378(87)90278-x

Cited by 147 publications

(59 citation statements)

References 4 publications

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“…Brachial plexus palsy in newborns occurs immediately after birth, as a result of lesions of the plexus nerves from various causes (18,19). After analyzing the data it was found that a greater number of males are affected as compared to female babies.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Brachial Plexus Palsy in Newborns

et al. 2014

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Objective -The aim of this study was to analyze the frequency of brachial palsy by gender, type, side, the newborn mother's parity and to identify its potential risk factors. Material and methods -Eighty-four newborn infants with brachial palsy were studied retrospectively at the University Clinical Center of Kosovo. The disease was confirmed by physical examination, neurological examination, and radiography. Results -The majority of newborns included in this study were male, with the Erb-Duchene type of brachial palsy. A greater number of newborn infants (70.2%) had sustained injuries to the right side. The most frequent occurrence was to the firstborn baby. Shoulder dystocia (39.3%), macrosomia (16.7%) and vaginal breech delivery (13.1%) were the most frequent potential risk factors identified in this study. The incidence of plexus brachial injury ranges from 1.8 to 3.35, depending on the ordinal number of the mother's delivery. The highest incidence is in mothers on their first-delivery, while the lowest is for those having the second child. The overall average incidence rate of brachial palsy is 2.62 per 1000 newborns. Conclusion -Our study has shown that the incidence of brachial plexus palsy is relatively high in newborns. Newborns with shoulder dystocia, macrosomia, and those born by vaginal breech delivery are at greater risk for brachial plexus palsy. Further research should be focused on the treatment and rehabilitation of children with brachial plexus palsy.

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Section: Discussionmentioning

confidence: 99%

Epidemiology of Brachial Plexus Palsy in Newborns

et al. 2014

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“…Others (46,97,98) go so far as to venture that "OBPP is avoidable by never applying head traction during any delivery and by using manoeuvres to deliver the shoulders that avoid any tension on the brachial plexus. Do not be tempted to use further traction until another corrective manoeuvre has been achieved.…”

Section: The Mechanism Of the Force Factormentioning

confidence: 99%

“…Do not be tempted to use further traction until another corrective manoeuvre has been achieved. Never use excessive force and do not use fundal pressure because this pressure risks uterine and fetal damage and serves only to impact the anterior shoulder more firmly onto the pubic symphysis" (46,97,98).…”

Section: The Mechanism Of the Force Factormentioning

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

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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...

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“…18 reports* in which the rate of this outcome attributable to, or associated with, shoulder dystocia could be determined. In 15t of these reports, which included almost 1100 cases of shoulder dystocia, there were no attributable deaths.…”

Section: Commentmentioning

confidence: 99%