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5 - The risk factors and perinatal outcomes of shoulder dystocia during delivery
Ali Doğukan Anğın, Osman Temizkan, Resul Karakuş, İlhan Şanverdi, Mesut Polat, Pınar Anğın, Selçuk Selçuk
Objective: SD (shoulder dystocia) is an uncommon and unpredictable event complicating 0.23% of all vaginal deliveries. We sought to examine the current risk factors and perinatal outcomes of all cases of shoulder dystocia in a single institution over a five years period.
Material and Method: This is a retrospective study carried out at a large tertiary referral center serving a single urban population over a 5 years period from 1998-2013. Shoulder dystocia was defined as failure to deliver the shoulders at the first attempt in singleton cephalic vaginal deliveries. Details of maternal demographics, intrapartum characteristics and neonatal outcomes were recorded prospectively on a computerized database for analysis.
Results: Last five years, total number of vaginal birth was 31,497 and the incidance of shoulder dystocia was %0.1 (n=33) in this period. In the shoulder dystocia cases %21 (n=7) of them had gestational diabetes mellitus and only 21% of the patients (n=7) were nulliparous. In %39 (n:13) of newborns who had sshoulder dystocia were observed signs of brachial plexus injury like moro reflex loss. Newborns who had shoulder dystocia, %39 (n:13) had 4000 gr and above birthweight but only one of the newborns (%3) who had shoulder dystocia had antenatal ultrasonographic measurement of estimated fetal weight over 4000 grams (4050 gr). 3(%9) of newborns needed to be followed up in neonatal intensive care unit. Newborns who had shoulder dystocia were divided into two groups: babies with (n=18, %54) or without (n=15, %46) complication because of shoulder dystocia. Brachial plexus palsy was significantly more common among episiotomy + maneuver, compared with maneuver-only and episiotomy-only (p:0.046).
Conclusion: We consider this robust and significant data relating to contemporary antecedents and outcomes of SD. As a complication which carries a significant risk of persistent neurological injury for the infant and consequent medicolegal implications for the clinician, continuous audit and high levels of awareness and training for all birth attendants should now be standard practice.
Keywords: Shoulder dystocia, risk factors, perinatal outcomes
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