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Am J Perinatol
DOI: 10.1055/a-1787-6991
Original Article

Fetal Growth Biometry as Predictors of Shoulder Dystocia in a Low-Risk Obstetrical Population

Roger B. Newman
1   Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
,
Danielle R. Stevens
2   Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
,
Kelly J. Hunt
2   Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
,
William A. Grobman
3   Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
,
John Owen
4   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Anthony Sciscione
5   Department of Obstetrics and Gynecology, Christiana Health Care Center, Wilmington, Delaware
,
Ronald J. Wapner
6   Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
,
Daniel Skupski
7   Department of Obstetrics and Gynecology, New York Presbyterian Queens, Flushing, New York
,
Edward K. Chien
8   Department of Obstetrics and Gynecology, Case Western Reserve University, Metro Health Medical Center, Cleveland, Ohio
,
Deborah A. Wing
9   Department of Obstetrics and Gynecology, University of California, Irvine; Orange, California
10   Department of Obstetrics and Gynecology, Fountain Valley Regional Hospital and Medical Center, Fountain Valley, California
,
Angela C. Ranzini
8   Department of Obstetrics and Gynecology, Case Western Reserve University, Metro Health Medical Center, Cleveland, Ohio
11   Department of Obstetrics and Gynecology, Saint Peter's University Hospital, New Brunswick, New Jersey
,
Manuel Porto
9   Department of Obstetrics and Gynecology, University of California, Irvine; Orange, California
,
Katherine L. Grantz
12   Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
› Institutsangaben Funding This research was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health and included American Recovery and Reinvestment Act (ARRA) funding (contract numbers: HHSN275200800013C; HHSN275200800002I; HHSN27500006; HHSN275200800003IC; HHSN275200800014C; HHSN275200800012C; HHSN275200800028C; and HHSN275201000009C).
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Abstract

Objective This study aimed to evaluate fetal biometrics as predictors of shoulder dystocia (SD) in a low-risk obstetrical population.

Study Design Participants were enrolled as part of a U.S.-based prospective cohort study of fetal growth in low-risk singleton gestations (n = 2,802). Eligible women had liveborn singletons ≥2,500 g delivered vaginally. Sociodemographic, anthropometric, and pregnancy outcome data were abstracted by research staff. The diagnosis of SD was based on the recorded clinical impression of the delivering physician. Simple logistic regression models were used to examine associations between fetal biometrics and SD. Fetal biometric cut points, selected by Youden's J and clinical determination, were identified to optimize predictive capability. A final model for SD prediction was constructed using backward selection. Our dataset was randomly divided into training (60%) and test (40%) datasets for model building and internal validation.

Results A total of 1,691 women (98.7%) had an uncomplicated vaginal delivery, while 23 (1.3%) experienced SD. There were no differences in sociodemographic or maternal anthropometrics between groups. Epidural anesthesia use was significantly more common (100 vs. 82.4%; p = 0.03) among women who experienced SD compared with those who did not. Amniotic fluid maximal vertical pocket was also significantly greater among SD cases (5.8 ± 1.7 vs. 5.1 ± 1.5 cm; odds ratio = 1.32 [95% confidence interval: 1.03,1.69]). Several fetal biometric measures were significantly associated with SD when dichotomized based on clinically selected cut-off points. A final prediction model was internally valid with an area under the curve of 0.90 (95% confidence interval: 0.81, 0.99). At a model probability of 1%, sensitivity (71.4%), specificity (77.5%), positive (3.5%), and negative predictive values (99.6%) did not indicate the ability of the model to predict SD in a clinically meaningful way.

Conclusion Other than epidural anesthesia use, neither sociodemographic nor maternal anthropometrics were significantly associated with SD in this low-risk population. Both individually and in combination, fetal biometrics had limited ability to predict SD and lack clinical usefulness.

Key Points

  • SD unpredictable in low-risk women.

  • Fetal biometry does not reliably predict SD.

  • Epidural use associated with increased SD risk.

  • SD prediction models clinically inefficient.

Keywords

fetal biometrics - fetal growth ultrasound - prediction of shoulder dystocia - asymmetric fetal growth

Note

The study is registered with the ClinicalTrials.gov, identifier: NCT00912132.


Supplementary Material



Publikationsverlauf

Eingereicht: 24. Februar 2021

Angenommen: 17. Februar 2022

Accepted Manuscript online:
03. März 2022

Artikel online veröffentlicht:
30. Juni 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Gherman RB. Shoulder dystocia: an evidence-based evaluation of the obstetric nightmare. Clin Obstet Gynecol 2002; 45 (02) 345-362
    CrossrefPubMedGoogle Scholar
  • 2 American College of Obstetricians and Gynecologists. Shoulder Dystocia. Washington, D.C. American College of Obstetricians and Gynecologists 2017 ACOG Practice Bulletin #178.
    PubMed
  • 3 Gross TL, Sokol RJ, Williams T, Thompson K. Shoulder dystocia: a fetal-physician risk. Am J Obstet Gynecol 1987; 156 (06) 1408-1418
    CrossrefPubMedGoogle Scholar
  • 4 Acker DB, Sachs BP, Friedman EA. Risk factors for shoulder dystocia. Obstet Gynecol 1985; 66 (06) 762-768
    PubMedGoogle Scholar
  • 5 Nesbitt TS, Gilbert WM, Herrchen B. Shoulder dystocia and associated risk factors with macrosomic infants born in California. Am J Obstet Gynecol 1998; 179 (02) 476-480
    CrossrefPubMedGoogle Scholar
  • 6 Chauhan SP, Grobman WA, Gherman RA. et al. Suspicion and treatment of the macrosomic fetus: a review. Am J Obstet Gynecol 2005; 193 (02) 332-346
    CrossrefPubMedGoogle Scholar
  • 7 Zhang X, Decker A, Platt RW, Kramer MS. How big is too big? The perinatal consequences of fetal macrosomia. Am J Obstet Gynecol 2008; 198 (05) 517.e1-517.e6
    CrossrefPubMedGoogle Scholar
  • 8 Elliott JP, Garite TJ, Freeman RK, McQuown DS, Patel JM. Ultrasonic prediction of fetal macrosomia in diabetic patients. Obstet Gynecol 1982; 60 (02) 159-162
    PubMedGoogle Scholar
  • 9 Chauhan SP, Lynn NN, Sanderson M, Humphries J, Cole JH, Scardo JA. A scoring system for detection of macrosomia and prediction of shoulder dystocia: a disappointment. J Matern Fetal Neonatal Med 2006; 19 (11) 699-705
    CrossrefPubMedGoogle Scholar
  • 10 Rouse DJ, Owen J, Goldenberg RL, Cliver SP. The effectiveness and costs of elective cesarean delivery for fetal macrosomia diagnosed by ultrasound. JAMA 1996; 276 (18) 1480-1486
    CrossrefPubMedGoogle Scholar
  • 11 Rouse DJ, Owen J. Prophylactic cesarean delivery for fetal macrosomia diagnosed by means of ultrasonography–a Faustian bargain?. Am J Obstet Gynecol 1999; 181 (02) 332-338
    CrossrefPubMedGoogle Scholar
  • 12 McFarland MB, Trylovich CG, Langer O. Anthropometric differences in macrosomic infants of diabetic and nondiabetic mothers. J Matern Fetal Med 1998; 7 (06) 292-295
    CrossrefPubMedGoogle Scholar
  • 13 Modanlou HD, Komatsu G, Dorchester W, Freeman RK, Bosu SK. Large-for-gestational-age neonates: anthropometric reasons for shoulder dystocia. Obstet Gynecol 1982; 60 (04) 417-423
    PubMedGoogle Scholar
  • 14 Cohen B, Penning S, Major C, Ansley D, Porto M, Garite T. Sonographic prediction of shoulder dystocia in infants of diabetic mothers. Obstet Gynecol 1996; 88 (01) 10-13
    CrossrefPubMedGoogle Scholar
  • 15 Cohen BF, Penning S, Ansley D, Porto M, Garite T. The incidence and severity of shoulder dystocia correlates with a sonographic measurement of asymmetry in patients with diabetes. Am J Perinatol 1999; 16 (04) 197-201
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 16 Miller RS, Devine PC, Johnson EB. Sonographic fetal asymmetry predicts shoulder dystocia. J Ultrasound Med 2007; 26 (11) 1523-1528
    CrossrefPubMedGoogle Scholar
  • 17 Burkhardt T, Schmidt M, Kurmanavicius J, Zimmermann R, Schäffer L. Evaluation of fetal anthropometric measures to predict the risk for shoulder dystocia. Ultrasound Obstet Gynecol 2014; 43 (01) 77-82
    CrossrefPubMedGoogle Scholar
  • 18 Endres L, DeFranco E, Conyac T. et al; CAOG FAR Research Network. Association of fetal abdominal-head circumference size difference with shoulder dystocia: a multicenter Study. AJP Rep 2015; 5 (02) e099-e104
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 19 Duryea EL, Casey BM, McIntire DD, Twickler DM. The FL/AC ratio for prediction of shoulder dystocia in women with gestational diabetes. J Matern Fetal Neonatal Med 2017; 30 (19) 2378-2381
    CrossrefPubMedGoogle Scholar
  • 20 Buck Louis GM, Grewal J, Albert PS. et al. Racial/ethnic standards for fetal growth: the NICHD Fetal Growth Studies. Am J Obstet Gynecol 2015; 213 (04) 449.e1-449.e41
    CrossrefPubMedGoogle Scholar
  • 21 Buck Louis GM, Grewal J. Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies' Research Team. Clarification of estimating fetal weight between 10-14 weeks gestation, NICHD fetal growth studies. Am J Obstet Gynecol 2017; 217 (01) 96-101
    CrossrefPubMedGoogle Scholar
  • 22 Grewal J, Grantz KL, Zhang C. et al. Cohort profile. NICHD fetal growth studies- singletons and twins. Int J Epidemiol 2018; 47 (01) 25-25l
    CrossrefPubMedGoogle Scholar
  • 23 Hadlock FP, Harrist RB, Sharman RS, Deter RL, Park SK. Estimation of fetal weight with the use of head, body, and femur measurements–a prospective study. Am J Obstet Gynecol 1985; 151 (03) 333-337
    CrossrefPubMedGoogle Scholar
  • 24 Hediger ML, Fuchs KM, Grantz KL. et al. Ultrasound quality assurance for singletons in the National Institute of Child Health and Human Development fetal growth studies. J Ultrasound Med 2016; 35 (08) 1725-1733
    CrossrefPubMedGoogle Scholar
  • 25 Youden WJ. Index for rating diagnostic tests. Cancer 1950; 3 (01) 32-35
    CrossrefPubMedGoogle Scholar
  • 26 Nocon JJ, McKenzie DK, Thomas LJ, Hansell RS. Shoulder dystocia: an analysis of risks and obstetric maneuvers. Am J Obstet Gynecol 1993;168(6, pt. 1):1732–1737, discussion 1737–1739
    PubMedGoogle Scholar
  • 27 Bryant DR, Leonardi MR, Landwehr JB, Bottoms SF. Limited usefulness of fetal weight in predicting neonatal brachial plexus injury. Am J Obstet Gynecol 1998; 179 (3, pt. 1): 686-689
    CrossrefPubMedGoogle Scholar
  • 28 Langer O, Berkus MD, Huff RW, Samueloff A. Shoulder dystocia: should the fetus weighing greater than or equal to 4000 grams be delivered by cesarean section?. Am J Obstet Gynecol 1991; 165 (4, pt. 1): 831-837
    PubMedGoogle Scholar
  • 29 Benedetti TJ, Gabbe SG. Shoulder dystocia. A complication of fetal macrosomia and prolonged second stage of labor with midpelvic delivery. Obstet Gynecol 1978; 52 (05) 526-529
    PubMedGoogle Scholar
  • 30 Levine AB, Lockwood CJ, Brown B, Lapinski R, Berkowitz RL. Sonographic diagnosis of the large for gestational age fetus at term: does it make a difference?. Obstet Gynecol 1992; 79 (01) 55-58
    PubMedGoogle Scholar
  • 31 Ong HC, Sen DK. Clinical estimation of fetal weight. Am J Obstet Gynecol 1972; 112 (07) 877-880
    CrossrefPubMedGoogle Scholar
  • 32 Kitzmiller JL, Mall JC, Gin GD, Hendricks SK, Newman RB, Scheerer L. Measurement of fetal shoulder width with computed tomography in diabetic women. Obstet Gynecol 1987; 70 (06) 941-945
    PubMedGoogle Scholar
  • 33 Rajan PV, Chung JH, Porto M, Wing DA. Correlation of increased fetal asymmetry with shoulder dystocia in the nondiabetic woman with suspected macrosomia. J Reprod Med 2009; 54 (08) 478-482
    PubMedGoogle Scholar
  • 34 Smith RB, Lane C, Pearson JF. Shoulder dystocia: what happens at the next delivery?. Br J Obstet Gynaecol 1994; 101 (08) 713-715
    CrossrefPubMedGoogle Scholar
  • 35 Lewis DF, Raymond RC, Perkins MB, Brooks GG, Heymann AR. Recurrence rate of shoulder dystocia. Am J Obstet Gynecol 1995; 172 (05) 1369-1371
    CrossrefPubMedGoogle Scholar
  • 36 Spong CY, Beall M, Rodrigues D, Ross MG. An objective definition of shoulder dystocia: prolonged head-to-body delivery intervals and/or the use of ancillary obstetric maneuvers. Obstet Gynecol 1995; 86 (03) 433-436
    CrossrefPubMedGoogle Scholar
  • 37 Jennett RJ, Tarby TJ, Kreinick CJ. Brachial plexus palsy: an old problem revisited. Am J Obstet Gynecol 1992;166(6, pt. 1):1673–1676, discussion 1676–1677
    PubMedGoogle Scholar
  • 38 Gonik B, Hollyer VL, Allen R. Shoulder dystocia recognition: differences in neonatal risks for injury. Am J Perinatol 1991; 8 (01) 31-34
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 39 Brunner Huber LR. Validity of self-reported height and weight in women of reproductive age. Matern Child Health J 2007; 11 (02) 137-144
    CrossrefPubMedGoogle Scholar
  • 40 Surén P, Gunnes N, Roth C. et al. Parental obesity and risk of autism spectrum disorder. Pediatrics 2014; 133 (05) e1128-e1138
    CrossrefPubMedGoogle Scholar
  • 41 American College of Obstetricians and Gynecologists. Ultrasound in Pregnancy. Washington, D.C. American College of Obstetricians and Gynecologists 2016 ACOG Practice Bulletin #175.
    PubMed
  • 42 Santos P, Hefele JG, Ritter G, Darden J, Firneno C, Hendrich A. Population-based risk factors for shoulder dystocia. J Obstet Gynecol Neonatal Nurs 2018; 47 (01) 32-42
    CrossrefPubMedGoogle Scholar
  • 43 Mollberg M, Hagberg H, Bager B, Lilja H, Ladfors L. High birthweight and shoulder dystocia: the strongest risk factors for obstetrical brachial plexus palsy in a Swedish population-based study. Acta Obstet Gynecol Scand 2005; 84 (07) 654-659
    CrossrefPubMedGoogle Scholar