Research
Population-Based Risk Factors for Shoulder Dystocia

https://doi.org/10.1016/j.jogn.2017.11.011Get rights and content

Abstract

Objective

To re-examine the risk factors for shoulder dystocia given the increasing rates of obesity and diabetes in pregnant women.

Design

Retrospective observational study.

Setting

Five hospitals located in Wisconsin, Florida, Maryland, Michigan, and Alabama.

Participants

We evaluated 19,236 births that occurred between April 1, 2011, and July 25, 2013.

Methods

Data were collected from electronic medical records and used to evaluate the risk of shoulder dystocia. Data were analyzed using a generalized linear mixed model, which controlled for clustering due to site.

Results

When insulin was prescribed, gestational diabetes was associated with an increased risk of shoulder dystocia (odds ratio = 2.10, 95% confidence interval [1.01, 4.37]); however, no similar association was found with regard to gestational diabetes treated with glycemic agents or through diet. Use of epidural anesthesia was associated with an increased risk for shoulder dystocia (odds ratio = 3.47, 95% confidence interval [2.72, 4.42]). Being Black or Hispanic, being covered by Medicaid or having no insurance, infant gestational age of 41 weeks or greater, and chronic diabetes were other significant risk factors.

Conclusion

With the changing characteristics of pregnant women, labor and birth clinicians care for more pregnant women who have an increased risk for shoulder dystocia. Our findings may help prospectively identify women with the greatest risk.

Keywords

maternal risk factors
perinatal
shoulder dystocia

Cited by (0)

Palmira Santos, PhD, is a scientist in the Institute for Healthcare Systems, Brandeis University, Waltham, MA.

Jennifer Gaudet Hefele, PhD, is an assistant professor in the Department of Gerontology, University of Massachusetts Boston, Boston, MA.

Grant Ritter, PhD, is an associate research professor in the Institute for Healthcare Systems, Brandeis University, Waltham, MA.

Jennifer Darden, BSN, is a clinical director of care excellence, Ascension, St. Louis, MO.

Cassandra Firneno, MA, is a research project manager, Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA.

Ann Hendrich, RN, PhD, FAAN, is Senior Vice President of Ascension, St. Louis, MO.

The authors report no conflict of interest or relevant financial relationships.

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