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

Tsur, Abraham; Rottenstreich, Amihai; Cahan, Tal; Shai, Daniel; Meyer, Raanan

doi:10.1007/s00404-020-05941-4

Cited by 4 publications

(7 citation statements)

References 13 publications

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“…Vacuum-assisted vaginal delivery is another historic obstetric risk factor for SD. 5,12,25 In our study, vacuum-assisted delivery remained an independent risk factor for SD in multivariable analysis as well as in the absence of LGA and diabetes in the classification tree model. It is unlikely that the vacuum device itself causes SD.…”

Section: Discussionsupporting

confidence: 49%

Incidence trends of shoulder dystocia and associated risk factors: A nationwide analysis in the United States

Youssefzadeh

Tavakoli

Panchal

et al. 2023

Intl J Gynecology & Obste

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Objective To examine recent incidence trends and characteristics of shoulder dystocia. Methods This is a retrospective cohort study querying the Healthcare Cost and Utilization Project's National Inpatient Sample. The study population included 9 913 838 vaginal deliveries for national estimates from January 2016 to December 2019. The main outcome measure was the diagnosis of shoulder dystocia. A binary logistic regression model was used to identify characteristics of shoulder dystocia in multivariable analysis. Results Shoulder dystocia was reported in 228 120 deliveries (23.0 per 1000). The incidence of shoulder dystocia increased from 21.0 to 24.6 per 1000 deliveries during the 4‐year study period (17.1% relative increase, P < 0.001). In a multivariable analysis, the recent year of delivery remained an independent factor for shoulder dystocia: adjusted odds ratio (aOR) compared with 2016, 1.09 (95% confidence interval [CI], 1.08–1.11), 1.13 (95% CI, 1.12–1.14), and 1.18 (95% CI, 1.16–1.19) for 2017, 2018, and 2019, respectively. Large for gestational age (aOR 4.33 [95% CI, 4.25–4.40]), diabetes mellitus (pregestational aOR, 4.78 [95% CI, 4.63–4.94], and gestational aOR, 1.69 [95% CI, 1.66–1.71]), and vacuum‐assisted delivery (aOR, 2.18 [95% CI, 2.15–2.21]) exhibited the largest risks for shoulder dystocia. Conclusion This national‐level analysis identified various risk factors for shoulder dystocia and demonstrated that shouder dystocia cases are increasing gradually in the United States.

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Section: Discussionsupporting

confidence: 49%

Incidence trends of shoulder dystocia and associated risk factors: A nationwide analysis in the United States

Youssefzadeh

Tavakoli

Panchal

et al. 2023

Intl J Gynecology & Obste

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“…Several previous studies did not describe the criteria for selection of shoulder dystocia cases [16][17][18][19][20][21]28]. The majority did not mention, which definition(s) were used, while some described that it depended on the judgment of the clinician in charge [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. RCOG's definition of shoulder dystocia or requirement of obstetric maneuvers was used in two previous studies only [27,28].…”

Section: Discussionmentioning

confidence: 99%

“…We suspected shoulder dystocia to be underrecoded and wanted to evaluate how accurately ICD-10 code O66.0 (obstructed labor due to shoulder dystocia) is being used. In the published literature, the incidence of shoulder dystocia is usually reported based on the diagnosis code in medical records, but it has been rarely specified, which diagnostic descriptions have been used [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. We hypothesized that diagnostic descriptions could be highly variable and wanted to assess, which descriptions were found in the shoulder dystocia cases of our study population and how they correlated with international guidelines.…”

Section: Introductionmentioning

confidence: 99%

Pitfalls in the diagnostics of shoulder dystocia: an analysis based on the scrutiny of 2274 deliveries

Heinonen

Saisto

Gissler

et al. 2023

Arch Gynecol Obstet

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Purpose Shoulder dystocia is an obstetric emergency with severe complications. Our objective was to evaluate the major pitfalls in the diagnostics of shoulder dystocia, diagnostic descriptions documented in medical records, use of obstetric maneuvers, and their correlations to Erb’s and Klumpke’s palsy and the use of ICD-10 code 066.0. Methods A retrospective, register-based case–control study included all deliveries (n = 181 352) in Hospital District of Helsinki and Uusimaa (HUS) area in 2006–2015. Potential shoulder dystocia cases (n = 1708) were identified from the Finnish Medical Birth Register and the Hospital Discharge Register using ICD-10 codes O66.0, P13.4, P14.0, and P14.1. After thorough assessment of all medical records, 537 shoulder dystocia cases were confirmed. Control group consisted of 566 women without any of these ICD-10 codes. Results The pitfalls in the diagnostic included suboptimal following of guidelines for making the diagnosis of shoulder dystocia, subjective interpretation of diagnostic criteria, and inexact or inadequate documentation in medical records. The diagnostic descriptions in medical record were highly inconsistent. The use of obstetric maneuvers was suboptimal among shoulder dystocia cases (57.5%). Overall, the use of obstetric maneuvers increased during the study period (from 25.7 to 97.0%, p < 0.001), which was associated with decreasing rate of Erb’s palsy and increasing use of ICD-10 code O66.0. Conclusion There are diagnostic pitfalls, which could be addressed by education regarding shoulder dystocia guidelines, by improved use obstetric maneuvers, and more precise documentation. The increased use of obstetric maneuvers was associated with lower rates of Erb’s palsy and improved coding of shoulder dystocia.

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“…A previous study conducted over three decades ago, focusing on an American population, reported a ShD rate of 0.5% (46/9046) among neonates weighing less than 3500 g. 14 The correlation between operative vaginal deliveries and ShD has been established in numerous prior studies, and this association is not a novel finding. 1,12 The heightened risk has been linked to several factors, including the likelihood that heavier neonates necessitate operative delivery more frequently due to prolonged second stage labor. Additionally, changes in the vectors of fetal head progression during operative vaginal delivery or an accelerated rate of fetal body progression (similar to precipitous labor) have also been considered as potential contributing factors.…”

Section: Discussionmentioning

confidence: 99%

“…11 Well established prominent risk factors for ShD include maternal diabetes, increasing fetal weight, fetal macrosomia, and the use of operative vaginal delivery. 1,12 We previously developed and validated a machine learning model that incorporates 18 well established risk factors to predict the occurrence of ShD. 13 Nevertheless, the clinical effectiveness of implementing the model has only been evaluated and confirmed in cases where the estimated fetal weight exceeds 4000 g. As a result, a significant unmet need remains in identifying risk factors for ShD among neonates who are appropriately sized for their gestational age.…”

Section: Introductionmentioning

confidence: 99%

Shoulder dystocia in deliveries of neonates <3500 grams

Levin,

Meyer,

Cahan

et al. 2023

Intl J Gynecology & Obste

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ObjectivesTo study risk factors for shoulder dystocia (ShD) among women delivering <3500 g newborn.MethodsA retrospective case–control study of all term live‐singleton deliveries during 2011–2019. Women with neonatal birthweight <3500 g were included. We compared cases of ShD to other deliveries by univariate and multivariable regression.ResultsThere were 79/41 092 (0.19%) cases of ShD among neonates <3500 g. In multivariable regression analysis, the following factors were independently associated with ShD; operative vaginal delivery (odds ratio [OR] 2.78; 95% confidence interval [CI]: 1.28–6.02, P = 0.009), vaginal birth after cesarean (VBAC, OR 2.74; 1.22–6.13, P = 0.010), sonographic abdominal circumference to biparietal diameter ratio (3.73 among ShD vs. 3.62, OR 1.35; 95% CI: 1.12–1.63, P = 0.001) and sonographic abdominal circumference to head circumference ratio (1.036 among ShD vs. 1.011, OR 3.04; 95% CI: 1.006–9.23, P = 0.049).ConclusionsThere is an association between operative vaginal delivery and ShD also in deliveries <3500 g. Importantly, the proportions between the fetal head and abdominal circumference are a better predictor of ShD than the newborn fetal weight and VBAC is associated with ShD.

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

Cited by 4 publications

References 13 publications

Incidence trends of shoulder dystocia and associated risk factors: A nationwide analysis in the United States

Incidence trends of shoulder dystocia and associated risk factors: A nationwide analysis in the United States

Pitfalls in the diagnostics of shoulder dystocia: an analysis based on the scrutiny of 2274 deliveries

Shoulder dystocia in deliveries of neonates <3500 grams

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