title: A multicenter assessment of 1,177 cases of shoulder dystocia: lessons learned.
abstract: The purposes of this review were to describe deliveries complicated by shoulder dystocia (SD) at three tertiary centers and discern the differences between SD with and without brachial plexus injury (BPI). The inclusion criteria for this multicenter, retrospective study were singletons, delivered vaginally with SD. To discern the risk factors for SD with and without injury, a case (SD and BPI) versus control (3 SD without injury at the same institution) design was used. Multiple linear regression was employed. Over a 7-year period, among 46,637 vaginal deliveries, SD occurred in 1,177 cases (2.5%) and BPI was noted in 11%. The results of multiple regression indicate that gestational age, operative delivery, and the number of maneuvers and concomitant fracture (4%) were statistically associated with BPI following SD (p < 0.001). SD was not associated with BPI in 89% and 88% of the cases that were resolved with McRoberts maneuver and suprapubic pressure, whereas only 0.2% of cases were litigated.
authors.affiliation: Department of Obstetrics and Gynecology, Eastern Virginia Medical Center, Norfolk, Virginia.
authors.forename: Suneet P
authors.initials: SP
authors.lastname: Chauhan
authors.affiliation: Department of Obstetrics and Gynecology, Spartanburg Regional Medical Center, Spartanburg, South Carolina.
authors.forename: M Ryan
authors.initials: MR
authors.lastname: Laye
authors.affiliation: Department of Obstetrics and Gynecology, Portsmouth Naval Hospital, Portsmouth, Virginia.
authors.forename: Monica
authors.initials: M
authors.lastname: Lutgendorf
authors.affiliation: Department of Obstetrics and Gynecology, Geisinger Specialty Clinic, Wilkes-Barre, Pennsylvania.
authors.forename: John W
authors.initials: JW
authors.lastname: McBurney
authors.affiliation: Department of Obstetrics and Gynecology, University of Mississippi, Jackson, Mississippi.
authors.forename: Sharon D
authors.initials: SD
authors.lastname: Keiser
authors.affiliation: Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Everett F
authors.initials: EF
authors.lastname: Magann
authors.affiliation: Department of Obstetrics and Gynecology, University of Mississippi, Jackson, Mississippi.
authors.forename: John C
authors.initials: JC
authors.lastname: Morrison
mesh_terms: D000293:Adolescent; D000328:Adult; D001720:Birth Injuries / Q000453:epidemiology*; D001917:Brachial Plexus / Q000293:injuries*; D016022:Case-Control Studies; D002968:Clavicle / Q000293:injuries*; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods*; D016640:Diabetes, Gestational / Q000453:epidemiology; D004420:Dystocia / Q000453:epidemiology*; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology; D050723:Fractures, Bone / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D006810:Humeral Fractures / Q000453:epidemiology*; D007751:Labor, Induced / Q000706:statistics & numerical data; D016014:Linear Models; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D000070599:Shoulder Injuries; D062606:Tertiary Care Centers; D055815:Young Adult