title: Shoulder dystocia related fetal neurological injuries: the predisposing roles of forceps and ventouse extractions.
abstract: On the basis of 333 documented cases of permanent perinatal neurological damage, associated with arrest of the shoulders at birth, the authors conducted a retrospective study in order to evaluate the predisposing role, if any, of the utilization of extraction instruments. The investigation revealed that 35% of all injuries occurred in neonates delivered by forceps, ventouse or sequential ventouse-forceps procedures. This frequency was several-fold higher than the prevailing instrument use in the practices of American obstetricians during the same years. A high rate of forceps and ventouse extractions was demonstrable in all birth weight categories. Average weight and moderately large for gestational age fetuses underwent instrumental extractions more often than grossly macrosomic ones. This circumstance indicates that forceps and ventouse are independent risk factors, unrelated to fetal size. Their use entailed central nervous system injuries significantly more often than did spontaneous deliveries. The findings suggest that extraction procedures may be as important as macrosomia among the factors that lead to neurological damage in the child in connection with shoulder dystocia. Because they augment the intrinsic dangers of excessive fetal size exponentially, the authors consider their use in case of > or =4,000 g estimated fetal weight inadvisable. Sequential forceps-ventouse utilization further doubles the risks and is, therefore, to be avoided in all circumstances.
authors: Department of Preventive Medicine, UMDNJ, New Jersey Medical School, Newark, NJ, USA. brimacmb@umdnj.edu
authors: Michael
authors: M
authors: Brimacombe
authors: Leslie
authors: L
authors: Iffy
authors: Joseph J
authors: JJ
authors: Apuzzio
authors: Valeria
authors: V
authors: Varadi
authors: Balint
authors: B
authors: Nagy
authors: Vijaya
authors: V
authors: Raju
authors: Nuris
authors: N
authors: Portuondo
mesh_terms: D001720:Birth Injuries / Q000453:epidemiology*; D001724:Birth Weight; D015984:Causality; D004420:Dystocia / Q000453:epidemiology* / Q000628:therapy; D005113:Extraction, Obstetrical / Q000009:adverse effects / Q000295:instrumentation* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D009772:Obstetrical Forceps / Q000009:adverse effects / Q000706:statistics & numerical data*; D011247:Pregnancy; D012189:Retrospective Studies; D012782:Shoulder; D020196:Trauma, Nervous System / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology