The risk of shoulder dystocia related permanent fetal injury in relation to birth weight

Leslie Iffy, Michael Brimacombe, Joseph J. Apuzzio, Valeria Varadi, Nuris Portuondo, B. Nagy

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objective: To examine birth weight related risks of fetal injury in connection with shoulder dystocia. Study design: The investigation was based on a retrospective analysis of 316 fetal neurological injuries associated with deliveries complicated by arrest of the shoulders that occurred across the United States. Results: The study revealed that the distribution of birthweights for the high risk shoulder dystocia population differs from the standard birthweight distribution. The relative difference per birthweight interval is used to adjust an assumed 1:1000 baseline risk of injury due to shoulder dystocia following vaginal deliveries. These adjusted risks show a need to consider new thresholds for elective cesarean delivery. Conclusions: Current North American and British guidelines, that set 5000 g as minimum estimated fetal weight limit for elective cesarean section in non-diabetic and 4500 g for diabetic gravidas, may expose some macrosomic fetuses to a high risk of permanent neurological damage. The authors present the opinion that the mother, having been informed of the risks of vaginal versus abdominal delivery, should be allowed to play an active role in the critical management decisions.

Original languageEnglish
Pages (from-to)53-60
Number of pages8
JournalEuropean Journal of Obstetrics Gynecology and Reproductive Biology
Volume136
Issue number1
DOIs
Publication statusPublished - Jan 2008

Fingerprint

Dystocia
Birth Weight
Wounds and Injuries
Cesarean Section
Fetal Weight
Fetus
Guidelines
Population

Keywords

  • Brachial plexus injury
  • Erb's palsy
  • Fetal macrosomia
  • Shoulder dystocia

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Reproductive Medicine

Cite this

The risk of shoulder dystocia related permanent fetal injury in relation to birth weight. / Iffy, Leslie; Brimacombe, Michael; Apuzzio, Joseph J.; Varadi, Valeria; Portuondo, Nuris; Nagy, B.

In: European Journal of Obstetrics Gynecology and Reproductive Biology, Vol. 136, No. 1, 01.2008, p. 53-60.

Research output: Contribution to journalArticle

Iffy, Leslie ; Brimacombe, Michael ; Apuzzio, Joseph J. ; Varadi, Valeria ; Portuondo, Nuris ; Nagy, B. / The risk of shoulder dystocia related permanent fetal injury in relation to birth weight. In: European Journal of Obstetrics Gynecology and Reproductive Biology. 2008 ; Vol. 136, No. 1. pp. 53-60.
@article{62c23a3feed94bd19642c1e4e4e6a91e,
title = "The risk of shoulder dystocia related permanent fetal injury in relation to birth weight",
abstract = "Objective: To examine birth weight related risks of fetal injury in connection with shoulder dystocia. Study design: The investigation was based on a retrospective analysis of 316 fetal neurological injuries associated with deliveries complicated by arrest of the shoulders that occurred across the United States. Results: The study revealed that the distribution of birthweights for the high risk shoulder dystocia population differs from the standard birthweight distribution. The relative difference per birthweight interval is used to adjust an assumed 1:1000 baseline risk of injury due to shoulder dystocia following vaginal deliveries. These adjusted risks show a need to consider new thresholds for elective cesarean delivery. Conclusions: Current North American and British guidelines, that set 5000 g as minimum estimated fetal weight limit for elective cesarean section in non-diabetic and 4500 g for diabetic gravidas, may expose some macrosomic fetuses to a high risk of permanent neurological damage. The authors present the opinion that the mother, having been informed of the risks of vaginal versus abdominal delivery, should be allowed to play an active role in the critical management decisions.",
keywords = "Brachial plexus injury, Erb's palsy, Fetal macrosomia, Shoulder dystocia",
author = "Leslie Iffy and Michael Brimacombe and Apuzzio, {Joseph J.} and Valeria Varadi and Nuris Portuondo and B. Nagy",
year = "2008",
month = "1",
doi = "10.1016/j.ejogrb.2007.02.010",
language = "English",
volume = "136",
pages = "53--60",
journal = "European Journal of Obstetrics and Gynecology and Reproductive Biology",
issn = "0028-2243",
publisher = "Elsevier Ireland Ltd",
number = "1",

}

TY - JOUR

T1 - The risk of shoulder dystocia related permanent fetal injury in relation to birth weight

AU - Iffy, Leslie

AU - Brimacombe, Michael

AU - Apuzzio, Joseph J.

AU - Varadi, Valeria

AU - Portuondo, Nuris

AU - Nagy, B.

PY - 2008/1

Y1 - 2008/1

N2 - Objective: To examine birth weight related risks of fetal injury in connection with shoulder dystocia. Study design: The investigation was based on a retrospective analysis of 316 fetal neurological injuries associated with deliveries complicated by arrest of the shoulders that occurred across the United States. Results: The study revealed that the distribution of birthweights for the high risk shoulder dystocia population differs from the standard birthweight distribution. The relative difference per birthweight interval is used to adjust an assumed 1:1000 baseline risk of injury due to shoulder dystocia following vaginal deliveries. These adjusted risks show a need to consider new thresholds for elective cesarean delivery. Conclusions: Current North American and British guidelines, that set 5000 g as minimum estimated fetal weight limit for elective cesarean section in non-diabetic and 4500 g for diabetic gravidas, may expose some macrosomic fetuses to a high risk of permanent neurological damage. The authors present the opinion that the mother, having been informed of the risks of vaginal versus abdominal delivery, should be allowed to play an active role in the critical management decisions.

AB - Objective: To examine birth weight related risks of fetal injury in connection with shoulder dystocia. Study design: The investigation was based on a retrospective analysis of 316 fetal neurological injuries associated with deliveries complicated by arrest of the shoulders that occurred across the United States. Results: The study revealed that the distribution of birthweights for the high risk shoulder dystocia population differs from the standard birthweight distribution. The relative difference per birthweight interval is used to adjust an assumed 1:1000 baseline risk of injury due to shoulder dystocia following vaginal deliveries. These adjusted risks show a need to consider new thresholds for elective cesarean delivery. Conclusions: Current North American and British guidelines, that set 5000 g as minimum estimated fetal weight limit for elective cesarean section in non-diabetic and 4500 g for diabetic gravidas, may expose some macrosomic fetuses to a high risk of permanent neurological damage. The authors present the opinion that the mother, having been informed of the risks of vaginal versus abdominal delivery, should be allowed to play an active role in the critical management decisions.

KW - Brachial plexus injury

KW - Erb's palsy

KW - Fetal macrosomia

KW - Shoulder dystocia

UR - http://www.scopus.com/inward/record.url?scp=37649019013&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=37649019013&partnerID=8YFLogxK

U2 - 10.1016/j.ejogrb.2007.02.010

DO - 10.1016/j.ejogrb.2007.02.010

M3 - Article

C2 - 17408846

AN - SCOPUS:37649019013

VL - 136

SP - 53

EP - 60

JO - European Journal of Obstetrics and Gynecology and Reproductive Biology

JF - European Journal of Obstetrics and Gynecology and Reproductive Biology

SN - 0028-2243

IS - 1

ER -