Shoulder dystocia: Should the fetus weighing ≥4000 grams be delivered by cesarean section?

Langer, Oded; Berkus, Michael D.; Huff, Robert W.; Samueloff, Arnon

doi:10.1016/0002-9378(91)90424-p

Cited by 271 publications

(94 citation statements)

References 8 publications

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“…Macrosomia was defined as a birthweight >4000 g. Although this cutoff is lower than that recommended for the general population, a birthweight X4000 g was thought to be the most appropriate cutoff for the diabetic population, based on the study of Langer et al 9 , where the majority of shoulder dystocia cases (84%) in the diabetic population occurred above this threshold. Given that macrosomia was a relatively common event and the fact that the odds ratio can overestimate the true risk of disease in this case, the predicted probabilities of macrosomia were then calculated from the logistic regression analysis and used to 20 Bootstrapping is a statistical technique used to estimate s.e.…”

Section: Methodsmentioning

confidence: 99%

“…[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%

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

et al. 2006

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2006

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“…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). However, there are also reports contradicting an increase in OBPP with increasing birth weight (72).The definition of macrosomia is not universal; cut-off points vary between 4000 g, 4500 g and 5000 g. The risk of shoulder dystocia due to macrosomia must be related to the mother's size and the capacity of her pelvis; the risk of shoulder dystocia thus varies with maternal height (73).…”

Section: Risk Factorsmentioning

confidence: 99%

“…shown that increasing birth weight is strongly associated with an increasing risk of shoulder dystocia (69,70,74). Many investigators focus on attempting to prevent shoulder dystocia rather than on the risks linked to obstetric manoeuvres to free the impacted shoulder (75).…”

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

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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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“…Macrosomia may lead to short-term complications such as increased rates of Caesarean section, shoulder dystocia and neonatal hypoglycaemia [5][6][7][8][9][10]. Long-term complications include an increased risk of obesity, diabetes and breast carcinoma later in life [11,12].…”

Section: Introductionmentioning

confidence: 99%

Sibling birthweight as a predictor of macrosomia in women with type 1 diabetes

2005

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Aims/hypothesis: The aim of this study was to establish the value of maternal HbA 1 c levels and older sibling birthweight as predictors of birthweight and macrosomia in the offspring of women with type 1 diabetes. Subjects and methods: A total of 214 pregnancies of 107 women with type 1 diabetes were studied. Regression analysis was performed to test the predictive value of the birthweight of the first-born infant, HbA 1 c levels, maternal BMI, maternal age and time between subsequent births on the birthweight of the second-born infant. Birthweights were corrected for sex and gestational age. The percentages of first-and second-born infants with macrosomia (weight >90th centile) were calculated and compared. Results: Only the birthweight of earlier born infants was significantly related to that of second-born infants (p<0.001) and 40-50% of the variation in the birthweight of second-born infants could be explained by the birthweight of the firstborn infants. About 85% of the mothers who gave birth to a macrosomic infant had a macrosomic infant in a subsequent pregnancy. Conclusions/interpretation: Although it is clear that glycaemic control contributes to birthweight in women with type 1 diabetes, the birthweight of an earlier born infant appears to be a much better predictor of the birthweight of a subsequent infant than HbA 1 c levels during pregnancy. It may, therefore, be used to identify patients at risk of giving birth to a macrosomic infant. Daily home monitoring of glucose levels, rather than HbA 1 c levels, should be used for assessment of maternal glycaemia during pregnancy.

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Shoulder dystocia: Should the fetus weighing ≥4000 grams be delivered by cesarean section?

Cited by 271 publications

References 8 publications

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

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

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

Sibling birthweight as a predictor of macrosomia in women with type 1 diabetes

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