title: Antepartum risks of shoulder dystocia and brachial plexus injury for infants weighing 4,200 g or more.
abstract: A cohort of 236 vaginally delivered neonates weighing > or = 4,200 g was evaluated. Shoulder dystocia was encountered in 27 deliveries (11.4%) and brachial plexus injury was diagnosed in 3 infants (1.3%). The 'traditional' antepartum risk factors could not be associated with shoulder dystocia. In this cohort, primiparity was significantly more frequent among the dystocia cases (OR = 8.58, 99% CI = 1.35-54.35, p = 0.021). Shoulder dystocia could not be attributed to a particular difference between the current and the previous heaviest birth weight. A policy of cesarean section for all infants weighing > or = 4,200 g would result in at least 5- to 6-fold increase in cesarean rate in this group of patients. Our data reconfirm that shoulder dystocia and brachial plexus injury are unpredictable, even in macrosomic infants. It is a matter of policy whether to accept the expected 1:9 and 1:79 respective risks associated with vaginal births.
authors.affiliation: Department of Obstetrics and Gynecology, Kaplan Hospital, Rehovot, Israel.
authors.forename: I
authors.initials: I
authors.lastname: Blickstein
authors.forename: A
authors.initials: A
authors.lastname: Ben-Arie
authors.forename: Z J
authors.initials: ZJ
authors.lastname: Hagay
mesh_terms: D000328:Adult; D001724:Birth Weight; D001917:Brachial Plexus / Q000293:injuries*; D002585:Cesarean Section; D004420:Dystocia / Q000209:etiology*; D005260:Female; D005320:Fetal Macrosomia / Q000150:complications*; D006801:Humans; D008423:Maternal Age; D010298:Parity; D011247:Pregnancy; D012307:Risk Factors; D012782:Shoulder