Relationship between head-to-body delivery interval in shoulder dystocia and neonatal depression

Obstet Gynecol. 2011 Aug;118(2 Pt 1):318-22. doi: 10.1097/AOG.0b013e31822467e9.

Abstract

Objective: To evaluate the relationship between the head-to-body delivery interval in shoulder dystocia, persistent brachial plexus injury, and neonatal depression.

Methods: We compared the head-to-body delivery intervals in 127 cases of uncomplicated shoulder dystocia-identified using medical record coding and verified by chart review in a university--affiliated community hospital--with a series of 55 medical-legal cases of shoulder dystocia with persistent brachial plexus injury, 14 of which included neonatal depression. Neonatal depression was defined as the presence of any of the following: fetal demise, cardiopulmonary resuscitation, intubation, umbilical artery pH lower than 7.00, or 5-minute Apgar score of 5 or lower.

Results: In the uncomplicated shoulder dystocia group, the median head-to-body delivery interval was 1.0 minute (interquartile range 0.5-1.0). The median for neonates with persistent brachial plexus injury and no depression was 2.0 minutes (interquartile range 1.0-4.0). For those with both persistent brachial plexus injury and neonatal depression, the median was significantly longer at 5.3 minutes (interquartile range 3.9-13.3), P<.001.

Conclusion: Neonates born with persistent brachial plexus injury and neonatal depression after shoulder dystocia had longer head-to-body delivery intervals than those with uncomplicated shoulder dystocia or shoulder dystocia with persistent brachial plexus injury without depression. By 4 minutes, all of the neonates with uncomplicated shoulder dystocia were born. Conversely, the majority of neonates with depression-57%-had head-to-body delivery intervals greater than 4 minutes. Such information offers guidance to clinicians caught between the admonition to apply only gentle force when utilizing maneuvers to accomplish a shoulder dystocia delivery and the countervailing need to achieve delivery within a critical time frame to prevent hypoxic injury.

Level of evidence: III.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Apgar Score
  • Birth Injuries / physiopathology*
  • Brachial Plexus / injuries*
  • Delivery, Obstetric*
  • Dystocia / physiopathology*
  • Dystocia / therapy
  • Female
  • Fetal Blood / chemistry
  • Fetal Distress / physiopathology
  • Humans
  • Hydrogen-Ion Concentration
  • Infant, Newborn
  • Pregnancy
  • Resuscitation
  • Time Factors