Shoulder dystocia in a 16-year experience in a teaching hospital.

OBJECTIVE

To determine incidence of shoulder dystocia and evaluate associated maternal, obstetric and fetal risk factors.

STUDY DESIGN

Records of patients and neonates with shoulder dystocia at delivery were studied for demography, labor complications and neonatal outcome. Two control cases who delivered vaginally following each patient were selected that matched the maternal demography of the patient group. Incidence of shoulder dystocia and related risk factors were analyzed and compared with controls. Maternal and fetal morbidity and mortality were determined.

RESULTS

Among 32,312 singleton vaginal deliveries, 104 cases of shoulder dystocia were recorded. Several reported high-risk factors related to increased incidence of shoulder dystocia reported were confirmed by the study, although 26% of the neonates with shoulder dystocia weighed < 4,000 g. Postpartum hemorrhage and third-degree perineal tear were significant complications; neonatal brachial plexus injury occurred in 20%, clavicle and humerus fracture in 10.6% and neonate asphyxiation in 8.6%. No maternal death occurred; high perinatal mortality was no surprise.

CONCLUSION

Training clinicians to manage shoulder dystocia is difficult because of rare occurrence and lack of standardized management; simulation training with mannequins is helpful. Obstetricians should formulate a management plan and act promptly and decisively when confronted with this complication.