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Wednesday
Jun172009

I Had Shoulder Dystocia Once. Will It Happen Again?

Recurrence of shoulder dystocia is a commonly searched phrase. The obstetrics textbook, Munro Kerr’s Operative Obstetrics (2007) by Baskett, et. al., states the following on pages 139-40:

The rate of repeat shoulder dystocia in a subsequent vaginal delivery has been reviewed in six series and the risk of recurrence ranges from 1.1% to 16.7%. The average recurrence rate was relatively low at 10.1%. However, in a case with previous shoulder dystocia and brachial plexus injury or other complication, caesarean section could be justified in the next pregnancy.

 

The six studies reviewed are below with a combined total of 2054 subjects. Data was collected between 1980 and 1999.

Smith RB, Lane C, Pearson JF. Shoulder dystocia: what happens at the next delivery? Br J Obstet Gynaecol. 1994 Aug;101(8):713-5.

Baskett TF. Shoulder dystocia. Best Pract Res Clin Obstet Gynaecol. 2002 Feb;16(1):57-68.

Lewis DF, Raymond RC, Perkins MB, Brooks GG, Heymann AR. Recurrence rate of shoulder dystocia. Am J Obstet Gynecol. 1995 May;172(5):1369-71.

Flannelly G, Simm A. A study of delivery following shoulder dystocia. British Congress of Obstetrics and Gynaecology, Dublin 4-7 July 1995. Abstract 516. London: Royal College of Obstetricians and Gynaecologists.

Olugbile A, Mascarenhas L. Review of shoulder dystocia at the Birmingham Women’s Hospital. J Obstet Gynaecol. 2000 May;20(3):267-70.

Ginsberg NA, Moisidis C. How to predict recurrent shoulder dystocia. Am J Obstet Gynecol. 2001 Jun;184(7):1427-9; discussion 1429-30.

 

Related Posts:

Can My Doctor Really Predict Shoulder Dystocia?

ACOG on Fallibility of Obstetric Judgment and Mode of Delivery

 

 

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Reader Comments (3)

I wish I had time to read all of your links, but my USMLE boards are tomorrow. Ugh.

I just wanted to say I researched this (not as thoroughly!) for a blog post recently, and it seems that repeat dystocias can be predicted. If your doctor thinks you have a large baby, then decides to induce and add pitocin augmentation to your labor, you have a more than 20 fold risk for a repeat dystocia. (I hope I am remembering the details right.) Simply a large baby did not hold a significantly higher risk.

So, if a physician chooses these interventions against the evidence out there, he or she can predict a much higher risk of dystocia.

June 18, 2009 | Unregistered CommenterMomTFH

Howdy, MomTFH. I remember that post well. It was the glorious trifecta of macrosomia, pitocin and induction that suggested a 23 fold increase in SD... basically iatrogenic shoulder dystocia.

Is Munro-Kerr's Operative Obstetrics one of your textbooks?

June 18, 2009 | Registered CommenterJill

Not yet! I am slowly adding obstetrics textbooks to my collection.

June 18, 2009 | Unregistered CommenterMomTFH
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