Determining factors associated with shoulder dystocia: a population-based study.
نویسندگان
چکیده
OBJECTIVE The study was aimed to define obstetric factors associated with shoulder dystocia. METHODS A population-based study comparing all singleton, vertex, term deliveries with shoulder dystocia with deliveries without shoulder dystocia was performed. Statistical analysis was done using multiple logistic regression analysis. RESULTS Shoulder dystocia complicated 0.2% (n = 245) of all deliveries included in the study (n = 107965). Independent risk factors for shoulder dystocia in a multivariable analysis were birth-weight > or =4000 g (OR = 24.3; 95% CI 18.5-31.8), vacuum delivery (OR = 5.7, 95% CI 3.4-9.5), diabetes mellitus (OR = 1.7, 95% CI 1.2-2.5) and lack of prenatal care (OR = 1.5, 95% CI 1.1-2.3). A significant linear association was found between birth-weight and shoulder dystocia, using the Mantel-Haenszel procedure. Pregnancies complicated with shoulder dystocia had higher rates of third-degree perineal tears as compared to the comparison group (0.8% versus 0.1%; P < 0.001). Similarly, perinatal mortality was higher among newborns delivered after shoulder dystocia as compared to the comparison group (3.7% versus 0.5%; OR = 7.4, 95% CI 3.5-14.9, P < 0.001). In addition, these newborns had higher rates of Apgar scores lower than 7 at 1 and 5 min as compared to newborns delivered without shoulder dystocia (29.7% versus 3.0%; OR = 13.8, 95% CI 10.3-18.4, P < 0.001 and 2.1% versus 0.3%; OR = 7.2, 95% CI 2.8-18.1, P < 0.001, respectively). Combining risk factors such as large for gestational age, diabetes mellitus and vacuum delivery increased the risk for shoulder dystocia to 6.8% (OR = 32.6, 95% CI 10.1-105.8, P < 0.001). CONCLUSIONS Independent factors associated with shoulder dystocia were birth-weight > or =4000 g, vacuum delivery, diabetes mellitus and lack of prenatal care.
منابع مشابه
Risk factors profile of shoulder dystocia in oman: a case control study.
OBJECTIVE This study aimed to assess the risk factor profile of shoulder dystocia and associated neonatal complications in Oman, a developing Arab country. METHODS A retrospective case-control study was conducted among 111 cases with dystocia and 111 controls, identified during 1994-2006 period in a tertiary care hospital in Oman. Controls were randomly selected among women who did not have d...
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ورودعنوان ژورنال:
- European journal of obstetrics, gynecology, and reproductive biology
دوره 126 1 شماره
صفحات -
تاریخ انتشار 2006