Neonatal and Maternal Outcomes following Shoulder Dystocia Resolution Utilizing ≥ versus < 3 Maneuvers

Area of Science:

• Obstetrics
• Neonatal outcomes
• Perinatal care

Background:

• Shoulder dystocia (SD) is a delivery complication with variable outcomes.
• Most cases of SD do not result in adverse events for mother or child.
• Assessing factors influencing SD outcomes is crucial for clinical practice.

Purpose of the Study:

• To determine if shoulder dystocia (SD) resolved with three or more maneuvers is associated with increased adverse neonatal outcomes compared to fewer maneuvers.
• To investigate the association between the number of maneuvers used for SD and the incidence of postpartum hemorrhage (PPH).

Main Methods:

• Secondary analysis of the Assessment of Perinatal Excellence (APEX) study, an observational cohort of over 115,000 deliveries.
• Included singleton, vertex, nonanomalous fetuses at ≥34 weeks with SD requiring at least one maneuver.
• Used modified-Poisson regression to calculate adjusted incidence relative risks (aIRR) for composite neonatal adverse outcomes and PPH.

Main Results:

• Shoulder dystocia occurred in 1.9% of deliveries; 18.9% required ≥3 maneuvers.
• SD requiring ≥3 maneuvers was associated with a significantly higher risk of a composite neonatal adverse outcome (aIRR: 2.08; 95% CI: 1.50-2.89).
• Specific adverse outcomes like low APGAR score, brachial plexus palsy, and hypoxic-ischemic encephalopathy were more likely with ≥3 maneuvers; PPH rates were similar.

Conclusions:

• Shoulder dystocia resolved with three or more maneuvers is associated with a doubled risk of composite neonatal adverse outcomes.
• The number of maneuvers used to resolve shoulder dystocia does not appear to influence the risk of postpartum hemorrhage.
• Clinicians should be aware of the increased neonatal risks associated with complex shoulder dystocia management.