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Impact of shoulder dystocia, stratified by type of manoeuvre, on severe neonatal outcome and maternal morbidity
Author(s) -
Michelotti Flurina,
Flatley Christopher,
Kumar Sailesh
Publication year - 2018
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/ajo.12718
Subject(s) - medicine , shoulder dystocia , odds ratio , obstetrics , retrospective cohort study , apgar score , vaginal delivery , pregnancy , gynecology , fetus , surgery , genetics , biology
Background Shoulder dystocia is an uncommon and unpredictable obstetric emergency. It is associated with significant neonatal, maternal and medico‐legal consequences. Aim To ascertain the impact shoulder dystocia has on severe neonatal and maternal outcomes specific to the type of manoeuvre. Materials and methods This was a retrospective study of 48 021 term singleton vaginal deliveries the Mater Mothers' Hospital in Brisbane between 2007 and 2015. Maternal and neonatal outcomes were compared between deliveries complicated by shoulder dystocia and those uncomplicated. Results Deliveries complicated by shoulder dystocia are associated with low Apgar scores (≤3) at five minutes ( odds ratio (OR) 5.25, 95% CI 3.23–8.56, P < 0.001), acidosis ( OR 3.10, 95% CI 2.76–3.50, P < 0.001), postpartum haemorrhage ( OR 2.28, 95% CI 1.90–2.75, P < 0.001) and perineal trauma ( OR 1.92, 95% CI 1.54–2.39, P < 0.001). Compared to McRoberts' manoeuvre and suprapubic pressure alone, the odds of serious neonatal outcome are increased with internal rotational manoeuvres ( OR 3.82, 95% CI 2.54–5.74, P < 0.001) and delivery of the posterior arm ( OR 4.49, 95% CI 3.54–5.69, P < 0.001). The OR of maternal injury is 2.07 (95% CI 1.77–2.45, P < 0.001), 2.26 (95% CI 1.21–4.21, P < 0.001) and 2.29 (95% CI 1.58–3.32, P < 0.001) with McRoberts'/suprapubic pressure, internal rotation and posterior arm delivery, respectively. Brachial plexus injuries and fractures complicate 1.4 and 0.9% of deliveries, with the risk of injury increasing when greater than one manoeuvre is required. Conclusion The risk of neonatal and maternal trauma is strongly associated with the number and types of manoeuvres. Given the associated implications, adequate antenatal counselling, simulation training and enhanced labour surveillance are essential.