title: Shoulder dystocia: definitions and incidence.
abstract: Though subjective in nature, both the American College of Obstetricians and Gynecologists practice bulletin and the Royal College of Obstetricians and Gynaecologists green guideline are in agreement on the descriptor of shoulder dystocia: requirement of additional obstetric maneuvers when gentle downward traction has failed to affect the delivery of the shoulders. The rate of shoulder dystocia is about 1.4% of all deliveries and 0.7% for vaginal births. Compared to non-diabetics (0.6%), among diabetics, the rate of impacted shoulders is 201% higher (1.9%); newborns delivered by vacuum or forceps have 254% higher likelihood of shoulder dystocia than those born spontaneously (2.0% vs. 0.6%, respectively). When the birthweight is categorized as <4000, 4000-4449, and >4500 g, the likelihood of shoulder dystocia in the US vs. other countries varies significantly. Future studies should focus on lowering the rate of shoulder dystocia and its associated morbidities, without concomitantly increasing the rate of cesarean delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Hansen
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, UT Health Science Center at Houston, Houston, Texas. Electronic address: chauhasp@evms.edu.
authors.forename: Suneet P
authors.initials: SP
authors.lastname: Chauhan
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000379:methods; D004420:Dystocia / Q000453:epidemiology* / Q000628:therapy; D004841:Episiotomy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012307:Risk Factors; D000070599:Shoulder Injuries; D009626:Terminology as Topic
keywords: Diabetes; Guidelines; Operative vaginal delivery; Shoulder dystocia