Prediction of shoulder dystocia in a contemporary birth cohort. Blackwell S.C. 2017. abstract bibtex OBJECTIVE: Shoulder dystocia has historically been an unpredictable and unpreventable complication of childbirth. Over the last 20 years patient characteristics, labor progress, and intrapartum management have dramatically changed. The objective of this study was to evaluate the association of traditional risk factors for shoulder dystocia in a contemporary labor cohort. STUDY DESIGN: This is a secondary analysis of a multi-center randomized clinical trial (RCT) of fetal monitoring with adjunctive ST segment analysis performed from 2010 to 2014 across 26 different hospitals in the US. Eligibility criteria were singleton gestation, GA \textgreater 36 weeks, planned labor attempt, and cervical exam 2-7 cm. The RCT reported no difference in the rates of cesarean delivery (CD) or adverse neonatal outcomes. The clinical characteristics and intrapartum outcomes of women with vaginal deliveries who developed shoulder dystocia were compared to those who did not. Data was collected by trained research nurses and shoulder dystocia was defined as the need to perform additional obstetrical maneuvers to effect vaginal delivery. Logistic regression analyses were performed to evaluate known clinical risk factors. RESULTS: There were 11,108 women in the study; 1,835 underwent cesarean delivery (16.5%) and 3.2% of the remainder developed shoulder dystocia (297/9,273). The table describes the frequency of shoulder dystocia in those with and without the various risk factors, and presents adjusted OR's when all factors are considered simultaneously. The most parsimonious model included DM, macrosomia, prolonged 2nd stage, and operative vaginal delivery, which had an Area Under the Curve of 0.67, (95% CI 0.64-0.70). Of the cohort 21.5% of women had 1 or more of these risk factors (n=1,984) but only 50.3% of shoulder dystocia cases occurred in this group (149/296). CONCLUSION: In this contemporary birth cohort, the strongest combination of risk factors for shoulder dystocia has not changed. In addition, predictive models for shoulder dystocia remain limited to adequately guide clinical practice. (Table Presented).
@misc{blackwell_s.c._prediction_2017,
title = {Prediction of shoulder dystocia in a contemporary birth cohort},
abstract = {OBJECTIVE: Shoulder dystocia has historically been an unpredictable and unpreventable complication of childbirth. Over the last 20 years patient characteristics, labor progress, and intrapartum management have dramatically changed. The objective of this study was to evaluate the association of traditional risk factors for shoulder dystocia in a contemporary labor cohort. STUDY DESIGN: This is a secondary analysis of a multi-center randomized clinical trial (RCT) of fetal monitoring with adjunctive ST segment analysis performed from 2010 to 2014 across 26 different hospitals in the US. Eligibility criteria were singleton gestation, GA {\textgreater} 36 weeks, planned labor attempt, and cervical exam 2-7 cm. The RCT reported no difference in the rates of cesarean delivery (CD) or adverse neonatal outcomes. The clinical characteristics and intrapartum outcomes of women with vaginal deliveries who developed shoulder dystocia were compared to those who did not. Data was collected by trained research nurses and shoulder dystocia was defined as the need to perform additional obstetrical maneuvers to effect vaginal delivery. Logistic regression analyses were performed to evaluate known clinical risk factors. RESULTS: There were 11,108 women in the study; 1,835 underwent cesarean delivery (16.5\%) and 3.2\% of the remainder developed shoulder dystocia (297/9,273). The table describes the frequency of shoulder dystocia in those with and without the various risk factors, and presents adjusted OR's when all factors are considered simultaneously. The most parsimonious model included DM, macrosomia, prolonged 2nd stage, and operative vaginal delivery, which had an Area Under the Curve of 0.67, (95\% CI 0.64-0.70). Of the cohort 21.5\% of women had 1 or more of these risk factors (n=1,984) but only 50.3\% of shoulder dystocia cases occurred in this group (149/296). CONCLUSION: In this contemporary birth cohort, the strongest combination of risk factors for shoulder dystocia has not changed. In addition, predictive models for shoulder dystocia remain limited to adequately guide clinical practice. (Table Presented).},
journal = {American Journal of Obstetrics and Gynecology},
author = {{Blackwell S.C.}},
year = {2017},
keywords = {*prediction, *shoulder dystocia, ST segment, animal model, area under the curve, cesarean section, clinical practice, clinical trial, controlled clinical trial, controlled study, disease model, female, fetus monitoring, hospital, human, logistic regression analysis, macrosomia, major clinical study, nurse, pregnancy, randomized controlled trial, risk factor, secondary analysis, vaginal delivery}
}
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STUDY DESIGN: This is a secondary analysis of a multi-center randomized clinical trial (RCT) of fetal monitoring with adjunctive ST segment analysis performed from 2010 to 2014 across 26 different hospitals in the US. Eligibility criteria were singleton gestation, GA \\textgreater 36 weeks, planned labor attempt, and cervical exam 2-7 cm. The RCT reported no difference in the rates of cesarean delivery (CD) or adverse neonatal outcomes. The clinical characteristics and intrapartum outcomes of women with vaginal deliveries who developed shoulder dystocia were compared to those who did not. Data was collected by trained research nurses and shoulder dystocia was defined as the need to perform additional obstetrical maneuvers to effect vaginal delivery. Logistic regression analyses were performed to evaluate known clinical risk factors. RESULTS: There were 11,108 women in the study; 1,835 underwent cesarean delivery (16.5%) and 3.2% of the remainder developed shoulder dystocia (297/9,273). The table describes the frequency of shoulder dystocia in those with and without the various risk factors, and presents adjusted OR's when all factors are considered simultaneously. The most parsimonious model included DM, macrosomia, prolonged 2nd stage, and operative vaginal delivery, which had an Area Under the Curve of 0.67, (95% CI 0.64-0.70). Of the cohort 21.5% of women had 1 or more of these risk factors (n=1,984) but only 50.3% of shoulder dystocia cases occurred in this group (149/296). CONCLUSION: In this contemporary birth cohort, the strongest combination of risk factors for shoulder dystocia has not changed. In addition, predictive models for shoulder dystocia remain limited to adequately guide clinical practice. (Table Presented).","journal":"American Journal of Obstetrics and Gynecology","author":[{"firstnames":[],"propositions":[],"lastnames":["Blackwell S.C."],"suffixes":[]}],"year":"2017","keywords":"*prediction, *shoulder dystocia, ST segment, animal model, area under the curve, cesarean section, clinical practice, clinical trial, controlled clinical trial, controlled study, disease model, female, fetus monitoring, hospital, human, logistic regression analysis, macrosomia, major clinical study, nurse, pregnancy, randomized controlled trial, risk factor, secondary analysis, vaginal delivery","bibtex":"@misc{blackwell_s.c._prediction_2017,\n\ttitle = {Prediction of shoulder dystocia in a contemporary birth cohort},\n\tabstract = {OBJECTIVE: Shoulder dystocia has historically been an unpredictable and unpreventable complication of childbirth. Over the last 20 years patient characteristics, labor progress, and intrapartum management have dramatically changed. The objective of this study was to evaluate the association of traditional risk factors for shoulder dystocia in a contemporary labor cohort. STUDY DESIGN: This is a secondary analysis of a multi-center randomized clinical trial (RCT) of fetal monitoring with adjunctive ST segment analysis performed from 2010 to 2014 across 26 different hospitals in the US. Eligibility criteria were singleton gestation, GA {\\textgreater} 36 weeks, planned labor attempt, and cervical exam 2-7 cm. The RCT reported no difference in the rates of cesarean delivery (CD) or adverse neonatal outcomes. The clinical characteristics and intrapartum outcomes of women with vaginal deliveries who developed shoulder dystocia were compared to those who did not. Data was collected by trained research nurses and shoulder dystocia was defined as the need to perform additional obstetrical maneuvers to effect vaginal delivery. Logistic regression analyses were performed to evaluate known clinical risk factors. RESULTS: There were 11,108 women in the study; 1,835 underwent cesarean delivery (16.5\\%) and 3.2\\% of the remainder developed shoulder dystocia (297/9,273). The table describes the frequency of shoulder dystocia in those with and without the various risk factors, and presents adjusted OR's when all factors are considered simultaneously. The most parsimonious model included DM, macrosomia, prolonged 2nd stage, and operative vaginal delivery, which had an Area Under the Curve of 0.67, (95\\% CI 0.64-0.70). Of the cohort 21.5\\% of women had 1 or more of these risk factors (n=1,984) but only 50.3\\% of shoulder dystocia cases occurred in this group (149/296). CONCLUSION: In this contemporary birth cohort, the strongest combination of risk factors for shoulder dystocia has not changed. In addition, predictive models for shoulder dystocia remain limited to adequately guide clinical practice. 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