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Am J Perinatol 2021; 38(03): 278-282
DOI: 10.1055/s-0039-1696675
Original Article

Shoulder Dystocia during Delivery and Long-Term Neurological Morbidity of the Offspring

Ziv Harari   *
1   Goldman School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
,
Omri Zamstein‡   *
2   Division of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
,
Eyal Sheiner
1   Goldman School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
,
Tamar Wainstock
3   Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
› Author Affiliations Funding None.
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Abstract

Objective The study aimed to evaluate risk factors and implications of shoulder dystocia (SD) on the neurological outcome of successfully delivered offspring.

Study Design This is a cohort analysis including 207,571 deliveries. Risk factors for SD were evaluated using general estimation equation multivariable analyses. Offspring hospitalization incidence up to age 18 years due to neurological conditions was compared between both groups. Kaplan–Meyer curve was used to assess the cumulative hospitalization incidence. Cox proportional hazards model was used to control for confounders.

Results SD complicated 0.2% (n = 353) of deliveries included in the study (n = 207,571). Risk factors for SD were fetal macrosomia, maternal diabetes mellitus, male gender, and advanced maternal age (p < 0.05 for all). Higher perinatal mortality was observed among SD cases (2.8 vs. 0.4%, p < 0.001). In most of the investigated neurological conditions no significant differences were found between the groups. Comparable rates of cumulative neurological-related hospitalization were observed (log rank p-value = 0.342) as well as lack of association between SD and neurological hospitalization (adjusted HR = 0.73; 95% CI 0.36–1.47; p = 0.381) when controlled for gestational age.

Conclusion Risk factors for SD are macrosomia, diabetes mellitus, male gender, and advanced maternal age. SD is not associated with long-term neurological morbidity of the offspring.

Keywords

shoulder dystocia - neurological - risk factors - hospitalizations - offspring

Note

The abstract of this study was presented at the 39th Annual SMFM Pregnancy Meeting that took place on February 11 to 16, 2019 at the Caesars Palace in Las Vegas, NV (Submission Reference ID: 1013–000266). This study was conducted as part of the requirements for MD degree from the Goldman Medical School at the Faculty of Health Sciences, Ben-Gurion University of the Negev.


Authors' Contributions

Z.H., O.Z., and T.W. contributed toward establishing scientific background, data analysis and interpretation, initial draft of manuscript, manuscript revision. E.S. studied concept and design, did interpretation of results, and critical revision of manuscript. All authors read and approved the final manuscript as submitted.


* These authors contributed equally to the manuscript.


Supplementary Material



Publication History

Received: 23 May 2019

Accepted: 26 July 2019

Article published online:
06 September 2019

© 2019. Thieme. All rights reserved.

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