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Licensed Unlicensed Requires Authentication Published by De Gruyter June 29, 2020

Trends of changes in the specific contribution of selected risk factors for shoulder dystocia over a period of more than two decades

  • Leah Grossman EMAIL logo , Gali Pariente , Yael Baumfeld , David Yohay , Reut Rotem and Adi Y. Weintraub



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.


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.


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.


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.

Corresponding author: Leah Grossman, Department of Obstetrics and Gynecology, Soroka University Medical Center, POB 151, Beer-Sheva, 84101, Israel, Phone: +972-544855097, E-mail:


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.

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The Institutional Review Board, in accordance with the Helsinki declaration, approved the study (0104-18-SOR).


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Received: 2019-12-19
Accepted: 2020-05-12
Published Online: 2020-06-29
Published in Print: 2020-07-28

© 2020 Walter de Gruyter GmbH, Berlin/Boston

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