Shoulder dystocia: An analysis of risks and practice with macrosomic births

OBJECTIVE: The purpose was to examine risk factors associated with shoulder dvslocia (SO) in macrosomic newhorns. STUDY DESIGN: Using a data se! linking birth certilicates with malernal and newborn hospital discharge records from acute care civilian hospitals in CA in 1992. newborns weighting >3500 gins wilh SD were identified. RESULTS: There were 175.886 vaginal births >3500 gins of which B.Ü3S (S'i) had SD. SD increased wilh birth weight (BV) for both diabetic (DM) and non-DM patients, and assisted atrd unassisted deliveries (Figure. K-a>ds in kgs). After controlling for other parameters, the risk of SD was increased with DM (OR 1.7). assisted delivcrv (OR = 1.9). and induction ot labot (OR = 1 3). The C./S late lor B\V >-4500 gms was W, overall and .lO'V foi DM paticnts. CONCLUSION: The majority (61%) of niacrosomic infants (>4500 gms) are delivering vaginally. SD incresses with NW and other risk faciors (Figure). The degree of innvascd risk of SD can now ho quantitled, alloming better in it consent foi a irail of labor in cases of suspected macrosomia.