[Antepartal maternal risks for shoulder dystocia. An analysis of 224 744 births spontanous and vaginal and after the 37th week of gestation born in Hessen (2002-2008)].
PATIENTS RESPECTIVELY AND METHODS: 224,744 vaginal and spontanous births >or= the 37 (th) week of gestation were analysed (2002-2008) to calculate the maternal risks for shoulder dystocia (obesity BMI >30, high maternal weight gain >15 kg during pregnancy, Diabetes mellitus, Diabetes of gestation, duration of pregnancy >or= 298 days, multiparity >1 partus).


RESULTS
It could be demonstrated for the first time (Degree of evidence III B), that multiparity and the weight gain>15 kg elevate the rate of shoulder dystocia independant of the birth weight. At a birth weight below 4 000 g in addition to the multiparity and the weight gain the obesity BMI>30 elevate significant the rate of shoulder dystocia (Degree of Evidence III B). In the birth weight group >or=4,000 g Diabetes mellitus elevate the risk of shoulder dystocia in addition to multiparity and weight gain >15 kg (Degree of Evidence III B). Diabetes mellitus elevate the risk of shoulder dystocia only in combination with macrosomia >4 000 g.


CONCLUSIONS
The pregnant woman should be informed about the statistically proved different maternal risk factors for a shoulder dystocia and a possible paresis of the Plexus brachialis in relation to the fetal birth weight. The sensitivity of 60% of the sonographic estimation of the fetal birth weight is to low and cannot be the only content of an information about this danger for the newborn.
Wiesbaden. Pberle@t-online.de
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Berle
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Misselwitz
D000328:Adult; D001720:Birth Injuries / Q000453:epidemiology*; D004420:Dystocia / Q000453:epidemiology*; D005113:Extraction, Obstetrical / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D049590:Postpartum Period; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D000070599:Shoulder Injuries; D055815:Young Adult