Predictors of shoulder dystocia at the time of operative vaginal delivery. Am J Obstet Gynecol 2016 Nov;215(5):624.e1-624.e5
Date
10/30/2016Pubmed ID
27287683DOI
10.1016/j.ajog.2016.06.001Scopus ID
2-s2.0-84994427184 (requires institutional sign-in at Scopus site) 24 CitationsAbstract
BACKGROUND: It remains uncertain whether clinical factors known prior to delivery can predict which women are more likely to experience shoulder dystocia in the setting of operative vaginal delivery.
OBJECTIVE: We sought to identify whether shoulder dystocia can be accurately predicted among women undergoing an operative vaginal delivery.
STUDY DESIGN: This was a case-control study of women undergoing a low or outlet operative vaginal delivery from 2005 through 2014 in a single tertiary care center. Cases were defined as women who experienced a shoulder dystocia at the time of operative vaginal delivery. Controls consisted of women without a shoulder dystocia at the time of operative vaginal delivery. Variables previously identified to be associated with shoulder dystocia that could be known prior to delivery were abstracted from the medical records. Bivariable analyses and multivariable logistic regression were used to identify factors independently associated with shoulder dystocia. A receiver operating characteristic curve was created to evaluate the predictive value of the model for shoulder dystocia.
RESULTS: Of the 4080 women who met inclusion criteria, shoulder dystocia occurred in 162 (4.0%) women. In bivariable analysis, maternal age, parity, body mass index, diabetes, chorioamnionitis, arrest disorder as an indication for an operative vaginal delivery, vacuum use, and estimated fetal weight >4 kg were significantly associated with shoulder dystocia. In multivariable analysis, parity, diabetes, chorioamnionitis, arrest disorder as an indication for operative vaginal delivery, vacuum use, and estimated fetal weight >4 kg remained independently associated with shoulder dystocia. The area under the curve for the generated receiver operating characteristic curve was 0.73 (95% confidence interval, 0.69-0.77), demonstrating only a modest ability to predict shoulder dystocia before performing an operative vaginal delivery.
CONCLUSION: While risk factors for shoulder dystocia at the time of operative vaginal delivery can be identified, reliable prediction of shoulder dystocia in this setting cannot be attained.
Author List
Palatnik A, Grobman WA, Hellendag MG, Janetos TM, Gossett DR, Miller ESAuthor
Anna Palatnik MD Associate Professor in the Obstetrics and Gynecology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultCase-Control Studies
Decision Support Techniques
Delivery, Obstetric
Dystocia
Female
Humans
Infant, Newborn
Logistic Models
Male
Pregnancy
ROC Curve
Risk Assessment
Risk Factors
Sensitivity and Specificity
