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Epidemiologic aspects of shoulder dystocia-related neurological birth injuries

  • Maternal-Fetal Medicine
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Abstract

Purpose

The first part of the study involved data collection for the detection of geographic variations and chronologic fluctuations in the rates of shoulder dystocia. The second part of the research evaluated head-to-body delivery times in cases of arrest of the shoulders at birth that had resulted in fetal damage during the last four decades in the USA.

Methods

The study of geographic and chronologic changes in the rates of shoulder dystocia rested on reported statistics coming from the USA and 11 other countries. These data were obtained by computer search. Evaluation of head-to-body delivery times rested on 104 well-documented cases that resulted in permanent neonatal damage.

Results

Literary reports of shoulder dystocia indicate that the incidence of shoulder dystocia has increased in the USA about fourfold since the middle of the twentieth century. No comparable trend has been reported from most other countries. Study of head-to-body delivery times revealed that more than two-thirds of all injured fetuses had been extracted from the birth canal within 2 minutes.

Conclusions

Incidents of shoulder dystocia began to escalate in the USA during the 1980s, shortly after the introduction of “active management” of the birthing process. This new technique replaced a conservative philosophy which had recommended abstinence from intervention on the part of the accoucheur. The authors consider the interventionist approach largely responsible for the exponential increase in the rates of shoulder dystocia in the USA. They recommend adherence to the traditional method of delivery on the part of obstetricians in Europe and elsewhere.

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Notes

  1. The quoted book won the British Medical Association Medical Books Award (first prize) in its category.

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Acknowledgments

The authors wish to express their appreciation for substantial contributions to their research and valuable help in the course of many years with the collection, maintenance and analysis of the shoulder dystocia data base by Senior Administrator Margaret Lesniak, B.A., Attorneys Nuris Portuondo Esq., Pamela Pantages Esq. and Biostatistician Michael Brimacombe, Ph. D.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, UMDNJ, New Jersey Medical School, Newark, NJ, USA

    Leslie Iffy

  2. 5 Robin Hood Rd, Summit, NJ, 07901, USA

    Leslie Iffy

  3. Division of Neonatology, Maternity Hospital, Budapest, Hungary

    Valeria Varadi

  4. Divisions of Perinatology and Genetics, Maternity Hospital, Budapest, Hungary

    Zoltan Papp

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  1. Leslie Iffy
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  2. Valeria Varadi
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  3. Zoltan Papp
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Correspondence to Leslie Iffy.

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Iffy, L., Varadi, V. & Papp, Z. Epidemiologic aspects of shoulder dystocia-related neurological birth injuries. Arch Gynecol Obstet 291, 769–777 (2015). https://doi.org/10.1007/s00404-014-3453-8

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