The risk of shoulder dystocia related permanent fetal injury in relation to birth weight.
OBJECTIVE
To examine birth weight related risks of fetal injury in connection with shoulder dystocia.


METHODS
The investigation was based on a retrospective analysis of 316 fetal neurological injuries associated with deliveries complicated by arrest of the shoulders that occurred across the United States.


RESULTS
The study revealed that the distribution of birthweights for the high risk shoulder dystocia population differs from the standard birthweight distribution. The relative difference per birthweight interval is used to adjust an assumed 1:1000 baseline risk of injury due to shoulder dystocia following vaginal deliveries. These adjusted risks show a need to consider new thresholds for elective cesarean delivery.


CONCLUSIONS
Current North American and British guidelines, that set 5000 g as minimum estimated fetal weight limit for elective cesarean section in non-diabetic and 4500 g for diabetic gravidas, may expose some macrosomic fetuses to a high risk of permanent neurological damage. The authors present the opinion that the mother, having been informed of the risks of vaginal versus abdominal delivery, should be allowed to play an active role in the critical management decisions.
Iffy
Leslie
L
Department of Obstetrics and Gynecology, New Jersey Medical School, Newark, NJ 07103, USA. liffy@comcast.net
Brimacombe
Michael
M
Apuzzio
Joseph J
JJ
Varadi
Valeria
V
Portuondo
Nuris
N
Nagy
Balint
B
D000293:Adolescent; D000328:Adult; D001720:Birth Injuries / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D001724:Birth Weight; D002648:Child; D004420:Dystocia / Q000453:epidemiology; D005260:Female; D005320:Fetal Macrosomia; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D011247:Pregnancy; D012189:Retrospective Studies; D012306:Risk; D012782:Shoulder; D014481:United States / Q000453:epidemiology