A Study of the Diagnostic Accuracy of an Existing Multivariable Test to Predict Shoulder Dystocia
15 December 2018
06 May 2019
20 August 2019 (online)
Objectives To evaluate the diagnostic accuracy of a multivariable prediction model, the Shoulder Screen (Perigen, Inc.), and compare it with the American College of Obstetricians and Gynecologists (ACOG) guidelines to prevent harm from shoulder dystocia.
Study Design The model was applied to two groups of 199 patients each who delivered during a 4-year period. One group experienced shoulder dystocia and the other group delivered without shoulder dystocia. The model's accuracy was analyzed. The performance of the model was compared with the ACOG guideline.
Results The sensitivity, specificity, positive, and negative predictive values of the model were 23.1, 99.5, 97.9, and 56.4%, respectively. The sensitivity of the ACOG guideline was 10.1%. The false-positive rate of the model was 0.5%. The accuracy of the model was 61.3%.
Conclusion A multivariable prediction model can predict shoulder dystocia and is more accurate than ACOG guidelines.
- 1 Chauhan SP, Blackwell SB, Ananth CV. Neonatal brachial plexus palsy: incidence, prevalence, and temporal trends. Semin Perinatol 2014; 38 (04) 210-218
- 2 CRICO 2010 Annual Benchmarking Report: Malpractice Risks in Obstetrics. Available at: https://www.rmf.harvard.edu/Malpractice-Data/Annual-Benchmark-Reports/Risks-in-Obstetrics/ . Retrieved February 9, 2018
- 3 American College of Obstetricians and Gynecologists. Shoulder Dystocia. Practice Bulletin 178. Washington, DC: American College of Obstetricians and Gynecologists; 2017
- 4 American College of Obstetricians and Gynecologists. Task Force on Neonatal Brachial Plexus Palsy. Washington, DC: American College of Obstetricians and Gynecologists; 2014
- 5 Foad SL, Mehlman CT, Ying J. The epidemiology of neonatal brachial plexus palsy in the United States. J Bone Joint Surg Am 2008; 90 (06) 1258-1264
- 6 Ouzounian JG, Korst LM, Miller DA, Lee RH. Brachial plexus palsy and shoulder dystocia: obstetric risk factors remain elusive. Am J Perinatol 2013; 30 (04) 303-307
- 7 Parantainen J, Palomäki O, Talola N, Uotila J. Clinical and sonographic risk factors and complications of shoulder dystocia - a case-control study with parity and gestational age matched controls. Eur J Obstet Gynecol Reprod Biol 2014; 177: 110-114
- 8 Zuarez-Easton S, Zafran N, Garmi G, Nachum Z, Salim R. Are there modifiable risk factors that may predict the occurrence of brachial plexus injury?. J Perinatol 2015; 35 (05) 349-352
- 9 Dyachenko A, Ciampi A, Fahey J, Mighty H, Oppenheimer L, Hamilton EF. Prediction of risk for shoulder dystocia with neonatal injury. Am J Obstet Gynecol 2006; 195 (06) 1544-1549
- 10 Hamilton EF, Ciampi A, Dyachenko A, Lerner HM, Miner L, Sandmire HF. Is shoulder dystocia with brachial plexus injury preventable?. Fetal Matern Med Rev 2008; 19 (04) 293-310
- 11 Hill MG, Cohen WR. Shoulder dystocia: prediction and management. Womens Health (Lond) 2016; 12 (02) 251-261
- 12 Belfort MA, Dildy GA, Saade GR, Suarez V, Clark SL. Prediction of shoulder dystocia using multivariate analysis. Am J Perinatol 2007; 24 (01) 5-10
- 13 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
- 14 Deaver JE, Cohen WR. An approach to the prediction of neonatal Erb palsy. J Perinat Med 2009; 37 (02) 150-155
- 15 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
- 16 Dajani NK, Magann EF. Complications of shoulder dystocia. Semin Perinatol 2014; 38 (04) 201-204
- 17 Hehir MP, Mchugh AF, Maguire PJ, Mahony R. Extreme macrosomia--obstetric outcomes and complications in birthweights >5000 g. Aust N Z J Obstet Gynaecol 2015; 55 (01) 42-46
- 18 Iffy L, Varadi V, Papp Z. Epidemiologic aspects of shoulder dystocia-related neurological birth injuries. Arch Gynecol Obstet 2015; 291 (04) 769-777
- 19 American College of Obstetricians and Gynecologists. Macrosomia. Practice Bulletin 173. Washington, DC: American College of Obstetricians and Gynecologists; 2016
- 20 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
- 21 Dudley NJ. A systematic review of the ultrasound estimation of fetal weight. Ultrasound Obstet Gynecol 2005; 25 (01) 80-89
- 22 Alsulyman OM, Ouzounian JG, Kjos SL. The accuracy of intrapartum ultrasonongraphic fetal weight estimation. Am J Obstet Gynecol 1997; 177: 503-506
- 23 Daly MV, Bender C, Townsend KE, Hamilton EF. Outcomes associated with a structured prenatal counseling program for shoulder dystocia with brachial plexus injury. Am J Obstet Gynecol 2012; 207 (02) 123.e1-123.e5