title: Relationship between head-to-body delivery interval in shoulder dystocia and neonatal depression.
abstract: OBJECTIVE
  To evaluate the relationship between the head-to-body delivery interval in shoulder dystocia, persistent brachial plexus injury, and neonatal depression.
  
  
  METHODS
  We compared the head-to-body delivery intervals in 127 cases of uncomplicated shoulder dystocia-identified using medical record coding and verified by chart review in a university--affiliated community hospital--with a series of 55 medical-legal cases of shoulder dystocia with persistent brachial plexus injury, 14 of which included neonatal depression. Neonatal depression was defined as the presence of any of the following: fetal demise, cardiopulmonary resuscitation, intubation, umbilical artery pH lower than 7.00, or 5-minute Apgar score of 5 or lower.
  
  
  RESULTS
  In the uncomplicated shoulder dystocia group, the median head-to-body delivery interval was 1.0 minute (interquartile range 0.5-1.0). The median for neonates with persistent brachial plexus injury and no depression was 2.0 minutes (interquartile range 1.0-4.0). For those with both persistent brachial plexus injury and neonatal depression, the median was significantly longer at 5.3 minutes (interquartile range 3.9-13.3), P<.001.
  
  
  CONCLUSIONS
  Neonates born with persistent brachial plexus injury and neonatal depression after shoulder dystocia had longer head-to-body delivery intervals than those with uncomplicated shoulder dystocia or shoulder dystocia with persistent brachial plexus injury without depression. By 4 minutes, all of the neonates with uncomplicated shoulder dystocia were born. Conversely, the majority of neonates with depression-57%-had head-to-body delivery intervals greater than 4 minutes. Such information offers guidance to clinicians caught between the admonition to apply only gentle force when utilizing maneuvers to accomplish a shoulder dystocia delivery and the countervailing need to achieve delivery within a critical time frame to prevent hypoxic injury.
  
  
  METHODS
  III.
authors.affiliation: From Newton Wellesley Hospital, Newton, Massachusetts; Harvard Medical School, Boston, Massachusetts; Suffolk University Law School, Boston, Massachusetts; the Departments of Obstetrics and Gynecology, Franklin Square Hospital, Baltimore, Maryland, and McGill University, Montreal, Quebec, Canada; and PeriGen, Montreal, Quebec, Canada.
authors.forename: Henry
authors.initials: H
authors.lastname: Lerner
authors.forename: Katherine
authors.initials: K
authors.lastname: Durlacher
authors.forename: Samuel
authors.initials: S
authors.lastname: Smith
authors.forename: Emily
authors.initials: E
authors.lastname: Hamilton
mesh_terms: D001034:Apgar Score; D001720:Birth Injuries / Q000503:physiopathology*; D001917:Brachial Plexus / Q000293:injuries*; D036861:Delivery, Obstetric; D004420:Dystocia / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D005316:Fetal Distress / Q000503:physiopathology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D011247:Pregnancy; D012151:Resuscitation; D013997:Time Factors