title: Pregnancy week at delivery and the risk of shoulder dystocia: a population study of 2,014,956 deliveries.
abstract: OBJECTIVE
  To study whether pregnancy week at delivery is an independent risk factor for shoulder dystocia.
  
  
  METHODS
  Population study.
  
  
  METHODS
  Medical Birth Registry of Norway.
  
  
  METHODS
  All vaginal deliveries of singleton offspring in cephalic presentation in Norway during 1967 through 2009 (n = 2,014,956).
  
  
  METHODS
  The incidence of shoulder dystocia was calculated according to pregnancy week at delivery. The associations of pregnancy week at delivery with shoulder dystocia were estimated as crude and adjusted odds ratios using logistic regression analyses. We repeated the analyses in pregnancies with and without maternal diabetes.
  
  
  METHODS
  Shoulder dystocia at delivery.
  
  
  RESULTS
  The overall incidence of shoulder dystocia was 0.73% (n = 14,820), and the incidence increased by increasing pregnancy week at delivery. Birthweight was strongly associated with shoulder dystocia. After adjustment for birthweight, induction of labour, use of epidural analgesia at delivery, prolonged labour, forceps-assisted and vacuum-assisted delivery, parity, period of delivery and maternal age in multivariable analyses, the adjusted odds ratios for shoulder dystocia were 1.77 (1.42-2.20) for deliveries at 32-35 weeks of gestation, and 0.84 (0.79-0.88) at 42-43 weeks of gestation, using weeks 40-41 as the reference. In pregnancies affected by diabetes (n = 11,188), the incidence of shoulder dystocia was 3.95%, and after adjustment for birthweight the adjusted odds ratio for shoulder dystocia was 2.92 (95% CI 1.54-5.52) for deliveries at weeks 32-35 of gestation, and 0.91 (95% CI 0.50-1.66) at 42-43 weeks of gestation.
  
  
  CONCLUSIONS
  The risk of shoulder dystocia was associated with increased birthweight, diabetes, induction of labour, use of epidural analgesia at delivery, prolonged labour, forceps-assisted and vacuum-assisted delivery, parity and period of delivery but not with post-term delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Akershus University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: E A
authors.initials: EA
authors.lastname: Øverland
authors.forename: L J
authors.initials: LJ
authors.lastname: Vatten
authors.forename: A
authors.initials: A
authors.lastname: Eskild
mesh_terms: D000328:Adult; D016362:Analgesia, Obstetrical / Q000706:statistics & numerical data; D001724:Birth Weight; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D016640:Diabetes, Gestational / Q000453:epidemiology; D004420:Dystocia / Q000453:epidemiology*; D005113:Extraction, Obstetrical / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007233:Infant, Postmature; D007751:Labor, Induced / Q000706:statistics & numerical data; D016015:Logistic Models; D009664:Norway / Q000453:epidemiology; D016017:Odds Ratio; D011247:Pregnancy; D012307:Risk Factors; D012782:Shoulder; D047929:Term Birth; D055815:Young Adult
keywords: Birthweight; post-term; pregnancy week; risk factor; shoulder dystocia