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Obstet Gynecol. 2011 Aug;118(2 Pt 1):318-22. doi: 10.1097/AOG.0b013e31822467e9.

Relationship between head-to-body delivery interval in shoulder dystocia and neonatal depression.

Author information

1
Newton Wellesley Hospital, Newton, Massachusetts, USA. hmlerner@henrylerner.com

Erratum in

  • Obstet Gynecol. 2011 Nov;118(5):1184.

Abstract

OBJECTIVE:

To evaluate the relationship between the head-to-body delivery interval in shoulder dystocia, persistent brachial plexus injury, and neonatal depression.

METHODS:

We compared the head-to-body delivery intervals in 127 cases of uncomplicated shoulder dystocia-identified using medical record coding and verified by chart review in a university--affiliated community hospital--with a series of 55 medical-legal cases of shoulder dystocia with persistent brachial plexus injury, 14 of which included neonatal depression. Neonatal depression was defined as the presence of any of the following: fetal demise, cardiopulmonary resuscitation, intubation, umbilical artery pH lower than 7.00, or 5-minute Apgar score of 5 or lower.

RESULTS:

In the uncomplicated shoulder dystocia group, the median head-to-body delivery interval was 1.0 minute (interquartile range 0.5-1.0). The median for neonates with persistent brachial plexus injury and no depression was 2.0 minutes (interquartile range 1.0-4.0). For those with both persistent brachial plexus injury and neonatal depression, the median was significantly longer at 5.3 minutes (interquartile range 3.9-13.3), P<.001.

CONCLUSION:

Neonates born with persistent brachial plexus injury and neonatal depression after shoulder dystocia had longer head-to-body delivery intervals than those with uncomplicated shoulder dystocia or shoulder dystocia with persistent brachial plexus injury without depression. By 4 minutes, all of the neonates with uncomplicated shoulder dystocia were born. Conversely, the majority of neonates with depression-57%-had head-to-body delivery intervals greater than 4 minutes. Such information offers guidance to clinicians caught between the admonition to apply only gentle force when utilizing maneuvers to accomplish a shoulder dystocia delivery and the countervailing need to achieve delivery within a critical time frame to prevent hypoxic injury.

LEVEL OF EVIDENCE:

III.

PMID:
21775848
DOI:
10.1097/AOG.0b013e31822467e9
[Indexed for MEDLINE]

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