title: Shoulder dystocia in diabetic and non-diabetic pregnancies.
abstract: OBJECTIVE
  Shoulder dystocia remains an obstetric emergency. Maternal diabetes is considered to be one of the major risk factors for shoulder dystocia. The aim of this study was to analyze antepartum and peripartum risk factors and complications of shoulder dystocia in diabetic and non-diabetic women.
  
  
  METHODS
  We performed a retrospective analysis of 48 shoulder dystocia cases out of 28,485 vaginal deliveries of singleton, live-born infants over a 13 year period: 13 cases were diagnosed in diabetic women and 35 cases in non-diabetic women.
  
  
  METHODS
  The study was conducted in the 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland, from January 2000 to December 2012.
  
  
  RESULTS
  Compared to non-diabetic women, diabetic patients had significantly higher pre-pregnancy body weight (83.4±23.8 kg vs. 62.5±10.9 kg, p=0.002), higher pre-pregnancy BMI (30.2±6.8 kg/m2 vs. 22.9±4.3 kg/m2, p=0.0003), and lower gestational weight gain (11.4±6.2 kg vs. 16.0±4.7 kg, p=0.01). Diabetic women with shoulder dystocia were more likely to deliver before completion of the 38th week of gestation (30.8% vs. 5.7%, p=0.02) and had a higher incidence of 1st and 2nd stage perineal tears compared with the non-diabetic group (23.1% vs. 0%, p=0.02). There were two cases of symphysis pubis dehiscence in non-diabetic women. Children of diabetic mothers had a significantly higher birth weight (4,425.4±561.6 g vs. 4,006.9±452.8 g, p=0.03). Children of diabetic mothers with dystocia were at significantly higher risk of peripartum injuries (92.3% vs. 45.7%). A significant difference was observed in the percentage of brachial plexus palsy (61.5% vs. 17.1%). Children of diabetic women experiencing shoulder dystocia were more frequently affected by Erb's brachial plexus palsy and respiratory disturbances. These children had an increased likelihood of birth weights above the 90th percentile (not necessarily reaching 4,000 g) compared to children born to non-diabetic mothers.
  
  
  CONCLUSIONS
  Shoulder dystocia in women with diabetes mellitus during pregnancy was associated with earlier gestational age of labor, and these women were more frequently overweight. The newborns of diabetic mothers after shoulder dystocia appeared to be at an increased risk for perinatal morbidity compared to the newborns of non-diabetic mothers experiencing this complication.
authors.affiliation: 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw , Poland.
authors.forename: Aneta
authors.initials: A
authors.lastname: Malinowska-Polubiec
authors.affiliation: 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw , Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Romejko-Wolniewicz
authors.affiliation: 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw , Poland.
authors.forename: Oksana
authors.initials: O
authors.lastname: Szostak
authors.affiliation: 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw , Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Dobrowolska-Redo
authors.affiliation: Department of Neonatology and Neonatal Intensive Care, Medical University of Warsaw, Poland.
authors.forename: Justyna
authors.initials: J
authors.lastname: Tolloczko
authors.affiliation: 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw , Poland.
authors.forename: Julia
authors.initials: J
authors.lastname: Zareba-Szczudlik
authors.affiliation: 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw , Poland.
authors.forename: Roman
authors.initials: R
authors.lastname: Smolarczyk
authors.affiliation: 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw , Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Czajkowski
mesh_terms: D000328:Adult; D016640:Diabetes, Gestational / Q000453:epidemiology*; D004420:Dystocia / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011044:Poland / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011254:Pregnancy in Diabetics / Q000453:epidemiology*; D012307:Risk Factors