Abstract
Objectives
Shoulder dystocia (SD) is an obstetrical emergency with well-recognized risk factors. We aimed to identify trends of changes in the specific contribution of risk factors for SD over time.
Methods
A nested case control study comparing all singleton deliveries with and without SD was undertaken. A multivariable logistic regression model was used in order to identify independent risk factors for SD and a comparison of the prevalence and the specific contribution (odds ratio (OR)) of the chosen risk factors in three consecutive eight-year intervals from 1988 to 2014 was performed.
Results
During the study period, there were 295,946 deliveries. Of them 514 (0.174%) were complicated with SD. Between 1988 and 2014 the incidence of SD has decreased from 0.3% in 1988 to 0.1% in 2014. Using a logistic regression model grandmultiparity, diabetes mellitus (DM), fetal weight, and large for gestational age (LGA) were found to be independent risk factors for SD (OR 1.25 95% CI 1.04–1.51, p=0.02; OR 1.53 95% CI 1.19–1.97, p=0.001; OR 1.002 95% CI 1.001–1.002, p < 0.001; OR 3.88 95% CI 3.09–4.87, p < 0.001; respectively). While the OR for grandmultiparity, fetal weight, and LGA has significantly changed during the study period with a mixed trend, the OR of DM has demonstrated a significant linear increase over time.
Conclusions
The individual contribution of selected risk factors for the occurrence of SD has significantly changed throughout the years. The contribution of DM has demonstrated a linear increase over time, emphasizing the great impact of DM on SD.
Acknowledgments
This study was conducted as part of the requirements for graduation from the Goldman Medical School of the Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel.
Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The Institutional Review Board, in accordance with the Helsinki declaration, approved the study (0104-18-SOR).
References
1. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. Practice bulletin no 178: shoulder dystocia. Obstet Gynecol 2017;129:e123–33. https://doi.org/10.1097/aog.0000000000002043.10.1097/AOG.0000000000002043Search in Google Scholar PubMed
2. Mehta, SH, Sokol, RJ. Shoulder dystocia: risk factors, predictability, and preventability. Semin Perinatol 2014;38:189–93. https://doi.org/10.1053/j.semperi.2014.04.003.Search in Google Scholar
3. Dajani, K, Magann, EF. Complications of shoulder dystocia. Semin Perinatol 2014;38:201–4: https://doi.org/10.1053/j.semperi.2014.04.005.Search in Google Scholar
4. Gurewitsch, ED, Allen, RH. Reducing the risk of shoulder dystocia and associated brachial plexus injury. Obstet Gynecol Clin North Am 2011;38:247–69. https://doi.org/10.1016/j.ogc.2011.02.015.Search in Google Scholar
5. Santos, P, Hefele, JG, Ritter, G, Darden, J, Firneno, C, Hendrich, A. Population-based risk factors for shoulder dystocia. J Obstet Gynecol neonatal Nurs JOGNN 2018;47:32–42. https://doi.org/10.1016/j.jogn.2017.11.011.Search in Google Scholar
6. Eades, CE, Cameron, DM, Evans, JMM. Prevalence of gestational diabetes mellitus in Europe: A meta-analysis. Diabetes Res Clin Prac 2017;129:173–81. https://doi.org/10.1016/j.diabres.2017.03.030.Search in Google Scholar
7. Central Bureau of Statistics. Israel in figures. Israel: Central Bureau of Statistics; 2016.Search in Google Scholar
8. Searle, AK, Smithers, LG, Chittleborough, CR, Gregory, TA, Lynch, JW. Gestational age and school achievement: a population study. Arch Dis Child Fetal Neonatal Ed 2017;10:F409–16. http://dx.doi.org/10.1136/archdischild-2016-310950.10.1136/archdischild-2016-310950Search in Google Scholar PubMed
9. Harper, LM, Jauk, VC, Owen, J, Biggio, JR. The utility of ultrasound surveillance of fluid and growth in obese women. Am J Obstet Gynecol 2014;211:524.e1–8. https://doi.org/10.1016/j.ajog.2014.04.028.Search in Google Scholar
10. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. ACOG practice bulletin no. 204: fetal growth restriction. Obstet Gynecol 2019;133:e97–109. https://doi.org/10.1097/aog.0000000000003070.10.1097/AOG.0000000000003070Search in Google Scholar PubMed
11. Young, BC, Ecker, JL. Fetal macrosomia and shoulder dystocia in women with gestational diabetes: risks amenable to treatment? Curr Diab Rep 2013;13:12–8. https://doi.org/10.1007/s11892-012-0338-8.Search in Google Scholar
12. Abu-Ghanem, S, Sheiner, E, Sherf, M, Wiznitzer, A, Sergienko, R, Shoham-Vardi, I. Lack of prenatal care in a traditional community: trends and perinatal outcomes. Arch Gynecol Obstet 2012;285:1237–42. https://doi.org/10.1007/s00404-011-2153-x.Search in Google Scholar
13. McNamara, K, O’Donoghue, K, Greene, RA. Intrapartum fetal deaths and unexpected neonatal deaths in the Republic of Ireland: 2011–2014; a descriptive study. BMC Pregnancy Childbirth 2018;18:9. https://doi.org/10.1186/s12884-017-1636-6.Search in Google Scholar
14. Ananth, CV, Friedman, AM, Keyes, KM, Lavery, JA, Hamilton, A, Wright, JD. Primary and repeat cesarean deliveries: a population-based study in the United States, 1979–2010. Epidemiology 2017;28:567–74. https://doi.org/10.1097/ede.0000000000000658.Search in Google Scholar
15. El Madany, AA, Jallad, KB, Radi, FA, El Hamdan, H, O’deh, HM. Shoulder dystocia: anticipation and outcome. Int J Gynaecol Obstet 1991;34:7–12. https://doi.org/10.1016/0020-7292(91)90531-9.Search in Google Scholar
16. Larsen, S, Dobbin, J, McCallion, O, Eskild, A. Intrauterine fetal death and risk of shoulder dystocia at delivery. Acta Obstet Gynecol Scand 2016;95:1345–51. https://doi.org/10.1111/aogs.13033.Search in Google Scholar
17. Yasmeen, S, Danielsen, B, Moshesh, M, Gilbert, WM. Is grandmultiparity an independent risk factor for adverse perinatal outcomes?. J Matern Fetal Neonatal Med 2005;17:277–80. https://doi.org/10.1080/14767050500123798.Search in Google Scholar
18. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. Practice bulletin no. 173: fetal macrosomia. Obstet Gynecol 2016;128:e195–209. https://doi.org/10.1097/aog.0000000000001767.Search in Google Scholar
19. Dudley, NJ. A systematic review of the ultrasound estimation of fetal weight. Ultrasound Obstet Gynecol 2005;25:80–9.10.1002/uog.1751Search in Google Scholar
20. Nesbitt, TS, Gilbert, WM, Herrchen, B. Shoulder dystocia and associated risk factors with macrosomic infants born in California. Am J Obstet Gynecol 1998;179:476–80. https://doi.org/10.1016/S0002-9378(98)70382-5.Search in Google Scholar
21. Coomarasamy, A, Connock, M, Thornton, J, Khan, KS. Accuracy of ultrasound biometry in the prediction of macrosomia: a systematic quantitative review. BJOG 2005;112:1461–6. https://doi.org/10.1111/j.1471-0528.2005.00702.x.Search in Google Scholar
22. Chauhan, SP, Hendrix, NW, Magann, EF, Morrison, JC, Kenney, SP, Devoe, LD. Limitations of clinical and sonographic estimates of birth weight: experience with 1034 parturients. Obstet Gynecol 1998;91:72–7. https://doi.org/10.1016/S0029-7844(97)00585-1.Search in Google Scholar
23. Crowther, CA, Hiller, JE, Moss, JR, McPhee, AJ, Jeffries, WS, Robinson, JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005;352:2477–86. https://doi.org/10.1056/nejmoa042973.Search in Google Scholar
24. Nassar, AH, Fayyumy, R, Saab, W, Mehio, G, Usta, IM. Grandmultiparas in modern obstetrics. Am J Perinatol 2006;23:345–9. https://doi.org/10.1055/s-2006-947158.Search in Google Scholar
25. Roman, H, Robillard, PY, Verspyck, E, Hulsey, TC, Marpeau, L, Barau, G. Obstetric and neonatal outcomes in grand multiparity. Obstet Gynecol 2004;103:1294–9. https://doi.org/10.1097/01.aog.0000127426.95464.85.Search in Google Scholar
26. Shechter, Y, Levy, A, Wiznitzer, A, Zlotnik, A, Sheiner, E. Obstetric complications in grand and great grand multiparous women. J Matern Fetal Neonatal Med 2010;23:1211–7. https://doi.org/10.3109/14767051003615459.Search in Google Scholar
27. Lyrenäs, S. Labor in the grand multipara. Gynecol Obstet Invest 2002;53:6–12. https://doi.org/10.1159/000049403.Search in Google Scholar
28. Simmons, D, Shaw, J, McKenzie, A, Eaton, S, Cameron, AJ, Zimmet, P. Is grand multiparity associated with an increased risk of dysglycaemia?. Diabetologia 2006;49:1522–7. https://doi.org/10.1007/s00125-006-0276-6.Search in Google Scholar
29. Skajaa, GØ, Fuglsang, J, Kampmann, U, Ovesen, PG. Parity increases insulin requirements in pregnant women with Type 1 diabetes. J Clin Endocrinol Metab 2018;103:2302–8. https://doi.org/10.1210/jc.2018-00094.Search in Google Scholar
30. Joshi, NP, Kulkarni, SR, Chittaranjan, S, Joglekar, CV, Rao, S, Coyaji, KJ, et al. Increasing maternal parity predicts neonatal adiposity : Pune maternal nutrition study. Am J Obstet Gynecol 2005;193:783–9. https://doi.org/10.1016/j.ajog.2005.01.020.Search in Google Scholar
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