Shoulder dystocia: should the fetus weighing >=4000 grams be delivered by cesarean section?

Article Abstract:

Shoulder dystocia is a serious complication of labor in which the shoulder of the baby becomes lodged in the birth canal. To avoid damage to the fetus, many experts recommend cesarean section when the fetus is judged to weigh 4,500 grams or more. To learn more about the prevalence of shoulder dystocia in fetuses of differing weights, a study of 75,979 vaginal deliveries at one medical center was carried out. The investigators hoped to determine whether cesarean section was the best approach for delivering fetuses weighing 4,000 grams or more. Of particular interest was the incidence of shoulder dystocia among diabetic women, who are at risk for macrosomia (very large babies). The incidence of birth trauma and overall rate of dystocia were also examined. The rate of macrosomia (babies weighing 4,000 grams or more) among nondiabetics was 7.6 percent, while it was 20.6 percent for diabetics. The incidence of shoulder dystocia was 3.1 percent among diabetics and 0.5 percent among nondiabetics, yielding a relative risk for this condition among diabetics of 5.92. Infants of higher birth weights were increasingly likely to suffer shoulder dystocia. Among nondiabetics, 40 percent of the cases with this condition occurred in infants weighing more than 4,000 grams: among diabetics, 84 percent of the infants weighing 4,000 grams or more developed the complication. The infant that did develop shoulder dystocia was 10.49 times as likely as the one who did not to experience additional complications (death, trauma, low Apgar scores); this applied to infants of diabetics and nondiabetics. Further analysis showed that, in diabetic women, 80 percent of the cases of shoulder dystocia can be eliminated by cesarean section. This calculation used 4,250 grams as the cut-off point for elective cesarean section delivery and, if used, would not cause the cesarean section rate to rise appreciably. No clear cut-off point could be established for nondiabetics, but it is recommended that vaginal delivery be attempted for nondiabetic fetuses weighing 4,000 grams or more, with careful attention paid to possible complications of macrosomia. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Shoulder dystocia and associated risk factors with macrosomic infants born in California

Article Abstract:

Diabetic pregnant women whose fetuses are substantially bigger than normal should be offered a cesarean section to prevent shoulder dystocia. Shoulder dystocia is a difficult delivery because the infant's shoulders get stuck in the birth canal. It can result in injury to the infant. A survey of 175,886 vaginal births of infants weighing more than 3,500 grams found that 3% overall developed shoulder dystocia. The rates increased the larger the fetus was and the rates were even higher in diabetic women. Shoulder dystocia increased the risk of birth trauma, asphyxia and other complications.

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The MFMU Cesarean Registry: Impact of fetal size on trial of labor success for patients with previous cesarean for dystocia

Article Abstract:

The rate of successful trial of labor after previous cesarean delivery for dystocia is assessed in a large cohort based on the relative birth weights of the two pregnancies. It is likely that increased fetal size relative to previous birth weight plays a significant role in the outcome of a subsequent trial of labor for patients with previous cesarean delivery for dystocia, reducing chances of vaginal delivery.

United States, Health aspects, Methods, Birth weight, Cesarean section, Birth size

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