摘要
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 ≥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 ≥4000 g, vacuum delivery, diabetes mellitus and lack of prenatal care.
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 ≥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 ≥4000 g, vacuum delivery, diabetes mellitus and lack of prenatal care.
