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Shoulder dystocia. A complication of fetal macrosomia and prolonged second stage of labor with midpelvic delivery.
Obstetrics and Gynecology 1978 November
Shoulder dystocia is an infrequently encountered obstetric emergency varying in incidence from 0.15 to 0.60% of all deliveries. Previously identified risk factors include maternal obesity, previous infants weighing greater than 4 kg, maternal diabetes, and fetal macrosomia (greater than 4 kg). To evaluate the role of prolonged second stage of labor (PSS) as a warning sign for shoulder dystocia, 9864 deliveries at LAC-USC Women's Hospital were retrospectively reviewed. Ninety percent delivered vaginally and 4.89% had PSS with midpelvic delivery. Shoulder dystocia occurred in 0.37% of all vertex vaginal deliveries. In the absence of PSS and midpelvic delivery, the incidence of shoulder dystocia was 0.16%. However, with PSS and midpelvic delivery, the incidence of shoulder dystocia was 4.57% (P less than 0.01). Infants weighing in excess of 4 kg were at increased risk of shoulder dystocia compared with infants weighing less than 4 kg. When PSS occurred and midpelvic delivery was attempted, the incidence of shoulder dystocia was 21% in infants weighing in excess of 4 kg; 8% had had failed vaginal delivery. All shoulder dystocias and failed vaginal deliveries occurred after use of the vacuum extractor. Immediate neonatal injury was apparent in 47% of infants with shoulder dystocia after PSS with midpelvic delivery. There were no maternal or fetal deaths related to shoulder dystocia during the study period.
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