Recurrent shoulder dystocia: a review.

OBJECTIVE: The goals of this review were to determine the incidence of recurrent shoulder dystocia and the incidence of brachial plexus injury in such cases. MATERIALS AND METHODS: A search of PubMed was conducted between 1980 and March 2009. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. RESULTS: The search yielded 191 publications, of which 9 provided complete data; these were used to calculate the incidence of recurrent shoulder dystocia. The rate of shoulder dystocia in the prior pregnancies was 1.64% (31,311/1,911,014). Among 10,591 known subsequent vaginal births, the rate of recurrent shoulder dystocia was 12% (OR, 8.25; 95% CI, 7.77, 8.76). Brachial plexus injury occurred significantly more often during recurrent shoulder dystocia than during the first shoulder dystocia (4% vs. 1%; OR, 3.59; 95% CI, 2.44, 5.29; or 45/1000 vs. 13/1000 births). CONCLUSION: About 12% of parturients with a history of shoulder dystocia have a recurrent dystocia in the subsequent pregnancy, a risk of about 1 in 8. Brachial plexus injury occurs in 19/1000 vaginal births during the first episode of shoulder dystocia, and in 45/1000 vaginal births after recurrent dystocia. TARGET AUDIENCE: Obstetricians & Gynecologist, Family Physicians. LEARNING OBJECTIVES: After completion of this educational activity, the reader will be able to compare the risk of primary versus recurrent shoulder dystocia. Formulate counseling and treatment strategies for pregnant women who have had a prior pregnancy complicated by shoulder dystocia. Assess the strength of the evidence suggesting the risk of recurrent shoulder dystocia.

Shoulder dystocia: comparison of the ACOG practice bulletin with another national guideline.

Our objective was to compare national guidelines regarding shoulder dystocia. Along with the American College of Obstetricians and Gynecologists (ACOG) practice bulletin on shoulder dystocia, guidelines from England, Canada, Australia, and New Zealand were reviewed. The Royal College of Obstetricians and Gynaecologists (RCOG) guideline agrees with the ACOG definition of shoulder dystocia, but there are variances in the management of suspected macrosomia and resolution of impacted shoulders. How recommendations are categorized differ also. Only 53% (20 of 38) of eligible references are cited by both publications. The two national guidelines on shoulder dystocia have differences and disagreements with each other, raising concerns about how the literature is synthesized and which is more comprehensive.