title: Outcomes associated with a structured prenatal counseling program for shoulder dystocia with brachial plexus injury.
abstract: OBJECTIVE
  We examined outcomes that were associated with a novel program to identify patients who are at high risk for shoulder dystocia with brachial plexus injury.
  
  
  METHODS
  The program included a checklist of key risk factors and a multifactorial algorithm to estimate risk of shoulder dystocia with brachial plexus injury. We examined rates of cesarean delivery and shoulder dystocia in 8767 deliveries by clinicians who were enrolled in the program and in 11,958 patients of clinicians with no access to the program.
  
  
  RESULTS
  Key risk factors were identified in 1071 of 8767 mothers (12.2%), of whom 40 of 8767 women (0.46%) had results in the high-risk category. The rate of primary cesarean delivery rate was stable (21.2-20.8%; P = .57). Shoulder dystocia rates fell by 56.8% (1.74-0.75%; P = .002). The rates of shoulder dystocia and cesarean birth showed no changes in the group with no access to the program.
  
  
  CONCLUSIONS
  With the introduction of this program, overall shoulder dystocia rates fell by more than one-half with no increase in the primary cesarean delivery rate.
authors: Lifeline Medical Associates, Atlantic Health System, Morristown, NJ, USA.
authors: Mary Veronica
authors: MV
authors: Daly
authors: Christina
authors: C
authors: Bender
authors: Kathryn E
authors: KE
authors: Townsend
authors: Emily F
authors: EF
authors: Hamilton
mesh_terms: D000465:Algorithms; D001720:Birth Injuries / Q000453:epidemiology / Q000517:prevention & control*; D001917:Brachial Plexus / Q000293:injuries*; D002585:Cesarean Section / Q000706:statistics & numerical data; D003376:Counseling; D004420:Dystocia / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D022125:Lacerations / Q000453:epidemiology / Q000517:prevention & control; D009515:New Jersey; D010502:Perineum / Q000293:injuries; D011247:Pregnancy; D011295:Prenatal Care; D015397:Program Evaluation; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors