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Antenatal Prediction of Shoulder Dystocia and Birth Trauma Using Routine Maternal and Ultrasound Variables:
Anat Schwartz1, Monica Minopoli1, Chiara Di Ilio2
1Fetal Medicine Unit, St. George's University Hospitals NHS Foundation Trust, London, UK.
Summary
Antenatal prediction models using fetal abdominal circumference (AC) centile and maternal factors show improved prediction for shoulder dystocia and birth trauma compared to estimated fetal weight (EFW) thresholds. These models aid in risk stratification for delivery complications.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Clinical Prediction Modeling
Background:
- Shoulder dystocia and birth trauma are significant obstetric complications.
- Accurate antenatal prediction is crucial for risk management and intervention.
- Current methods using estimated fetal weight (EFW) have limitations.
Purpose of the Study:
- To develop and validate antenatal prediction models for shoulder dystocia and birth trauma.
- To compare the performance of models using maternal characteristics and fetal biometry (abdominal circumference centile - AC centile) against EFW thresholds.
Main Methods:
- Retrospective cohort study of singleton term pregnancies.
- Multivariable logistic regression used to develop prediction models.
- Variables included maternal characteristics and fetal biometry (AC centile, EFW).
- Model performance assessed by discrimination (AUC) and calibration.
Main Results:
- The model incorporating maternal characteristics and AC centile showed better discrimination than EFW-based thresholds.
- Optimism-corrected AUC for shoulder dystocia was 0.699; for birth trauma, it was 0.665.
- At a 10% false-positive rate, sensitivity for shoulder dystocia was 31.5% and for birth trauma was 22.8%.
Conclusions:
- Antenatal models combining fetal AC centile with maternal risk factors are superior to EFW thresholds for predicting shoulder dystocia and birth trauma.
- These models offer modest but potentially useful antenatal risk stratification and counselling capabilities.
- Further research into targeted interventions for high-risk pregnancies is warranted.
