title: [Composite prevention strategy for shoulder dystocia: meta-analysis].
abstract: OBJECTIVE
  To investigate the composite prevention strategy for shoulder dystocia.
  
  
  METHODS
  The published articles of randomized controlled trial (RCT) of comparison about the prevention of shoulder dystocia were searched in PubMed, EMBASE, EBSCO databases and Cochrane Library, and these studies were screened under inclusion and exclusion criteria. The quality of included studies were evaluated. And the Meta-analysis using statistic software RevMan 5.1 was completed.
  
  
  RESULTS
  Totally 16 articles, all English published with no one Chinese article being searched out, were included in this analysis, published from 1993 to 2009. ( 1)To the gestational diabetes mellitus (GDM) patients, reviewed from 2 articles, it was found that the incidence of shoulder dystocia was reduced significantly by prenatal intervention versus usual care (OR = 0.40, 95% CI:0.21- 0.75, P = 0.004). (2)To the GDM patients with intensive prenatal intervention, reviewed form 5 articles, it was found that the incidence of shoulder dystocia was reduced significantly by intensive intervention(diet control combined with insulin if necessary)versus less intensive intervention (only diet control), OR = 0.29 (95%CI:0.11-0.73, P = 0.009). (3) To the non-GDM patients with suspected macrosomia, reviewed from 4 articles, it was found that the incidence of shoulder dystocia was not reduced by early artificial induction of parturition (OR = 0.85, 95%CI:0.41-1.75, P = 0.660). (4)To the GDM patients, reviewed form 2 articles, it was found that the incidence of shoulder dystocia was reduced marginal significantly by artificial induction of parturition in 38-39 gestational weeks compared with all spontaneous parturition patients (OR = 0.18, 95%CI:0.03-0.97, P = 0.050) and significantly reduced when compared with those spontaneous parturition patients after 40 gestational weeks (OR = 0.13, 95%CI: 0.02-0.75, P = 0.020). (5)To the GDM patients with suspected macrosomia, reviewed from only one article, it was found that the incidence of shoulder dystocia was reduced marginal significantly by early artificial induction of parturition (OR = 0.34, 95%CI:0.12-0.99, P = 0.050). (6)Reviewed from 2 articles, it was found that the incidence of shoulder dystocia was not significantly reduced by the intrapartum prophylactic maneuvers (OR = 0.44, 95% CI:0.16-1.18, P = 0.100).
  
  
  CONCLUSIONS
  Some varieties of intervention for the high risk patients could reduced the occurrence of shoulder dystocia.
authors: Department of Obstetrics and Gynecology, Beijing Hospital, Beijing 100730, China. Email: w_sw999@163.com.
authors: Shaowei
authors: S
authors: Wang
authors: Department of Obstetrics and Gynecology, Beijing Hospital, Beijing 100730, China.
authors: Xiaodong
authors: X
authors: Zhao
authors: Department of Obstetrics and Gynecology, Beijing Hospital, Beijing 100730, China.
authors: Defa
authors: D
authors: Chu
authors: Department of Obstetrics and Gynecology, Beijing Hospital, Beijing 100730, China.
authors: Min
authors: M
authors: Li
authors: Department of Obstetrics and Gynecology, Beijing Hospital, Beijing 100730, China.
authors: Lin
authors: L
authors: Liang
authors: Department of Obstetrics and Gynecology, Beijing Hospital, Beijing 100730, China.
authors: Junrong
authors: J
authors: Zhang
mesh_terms: D001720:Birth Injuries / Q000517:prevention & control*; D001724:Birth Weight; D036861:Delivery, Obstetric / Q000379:methods*; D016640:Diabetes, Gestational / Q000175:diagnosis / Q000517:prevention & control; D004420:Dystocia / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007328:Insulin; D036801:Parturition; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000175:diagnosis / Q000517:prevention & control; D011295:Prenatal Care; D016032:Randomized Controlled Trials as Topic; D012782:Shoulder
chemical_list: D007328:Insulin