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Can shoulder dystocia be reliably predicted?
Author(s) -
Dodd Jodie M.,
Catcheside Britt,
Scheil Wendy
Publication year - 2012
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/j.1479-828x.2012.01425.x
Subject(s) - shoulder dystocia , medicine , logistic regression , confidence interval , odds ratio , obstetrics , population , birth weight , risk factor , predictive value , pregnancy , genetics , environmental health , biology
Aims To evaluate factors reported to increase the risk of shoulder dystocia, and to evaluate their predictive value at a population level. Methods The S outh A ustralian P regnancy O utcome U nit's population database from 2005 to 2010 was accessed to determine the occurrence of shoulder dystocia in addition to reported risk factors, including age, parity, self‐reported ethnicity, presence of diabetes and infant birth weight. Odds ratios (and 95% confidence interval) of shoulder dystocia was calculated for each risk factor, which were then incorporated into a logistic regression model. Test characteristics for each variable in predicting shoulder dystocia were calculated. Results As a proportion of all births, the reported rate of shoulder dystocia increased significantly from 0.95% in 2005 to 1.38% in 2010 ( P = 0.0002). Using a logistic regression model, induction of labour and infant birth weight greater than both 4000 and 4500 g were identified as significant independent predictors of shoulder dystocia. The value of risk factors alone and when incorporated into the logistic regression model was poorly predictive of the occurrence of shoulder dystocia. Conclusions While there are a number of factors associated with an increased risk of shoulder dystocia, none are of sufficient sensitivity or positive predictive value to allow their use clinically to reliably and accurately identify the occurrence of shoulder dystocia.