Fatal shoulder dystocia: a review of 56 cases reported to the Confidential Enquiry into Stillbirths and Deaths in Infancy.
OBJECTIVE
To use information collected by the Confidential Enquiry into Stillbirths and Deaths in Infancy to help obstetric, midwifery and paediatric practice in the management of shoulder dystocia.


METHODS
Review of casenotes by a multidisciplinary focus group.


METHODS
All 56 cases reported to the Confidential Enquiry into Stillbirths and Deaths in Infancy from England, Wales and Northern Ireland in 1994 and 1995, where stillbirth or neonatal death was attributed to shoulder dystocia.


METHODS
Case notes were reviewed with respect to a range of perinatal variables. Comparisons were made with normative data from other studies when appropriate.


RESULTS
Maternal obesity and big babies were over-represented in pregnancies complicated by fatal shoulder dystocia. Fetal compromise was recorded in 26% of labours. The median time interval between delivery of the head and the rest of the body was only five minutes. The lead professional at the time the head was delivered was a midwife in 65% of cases. Middle grade or senior obstetric staff were supervising 47% of cases by the time the body was delivered.


CONCLUSIONS
Antenatal prediction of shoulder dystocia is imprecise, and the majority of deliveries are attended by midwives. A relatively brief delay in delivery of the shoulders may be associated with a fatal outcome.
Hope
P
P
John Radcliffe Hospital, Headington, Oxford, UK.
Breslin
S
S
Lamont
L
L
Lucas
A
A
Martin
D
D
Moore
I
I
Pearson
J
J
Saunders
D
D
Settatree
R
R
D001344:Autopsy; D001724:Birth Weight; D036861:Delivery, Obstetric; D004420:Dystocia / Q000401:mortality*; D004739:England / Q000453:epidemiology; D005260:Female; D005313:Fetal Death / Q000453:epidemiology*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008880:Midwifery; D009660:Northern Ireland / Q000453:epidemiology; D011247:Pregnancy; D012782:Shoulder; D014852:Wales / Q000453:epidemiology