Shoulder dystocia: Definitions and incidence

• Published in: Seminars in perinatology Vol. 38; no. 4; pp. 184 - 188
• Main Authors: Hansen, Alexandra, MD, Chauhan, Suneet P., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2014
• Subjects: Cesarean Section - statistics & numerical data; Delivery, Obstetric - methods; Diabetes; Dystocia - epidemiology; Dystocia - therapy; Episiotomy - statistics & numerical data; Female; Guidelines; Humans; Incidence; Infant, Newborn; Male; Neonatal and Perinatal Medicine; Operative vaginal delivery; Practice Guidelines as Topic; Pregnancy; Risk Factors; Shoulder dystocia; Shoulder Injuries; Terminology as Topic; Operative vaginal delivery; Shoulder dystocia; Diabetes; Guidelines
• ISSN: 0146-0005; 1558-075X
• DOI: 10.1053/j.semperi.2014.04.002

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.