- Email: [email protected]
302: Shoulder dystocia maneuvers and neonatal outcomes
Poster Session II
Clinical Obstetrics, Diabetes, Labor, Medical-Surgical-Disease, Physiology/Endocrinology, Prematurity
www.AJOG.org
Cervical dilation and fetal descent curves for nulliparas and multiparas
301 A new standard for fetal descent in labor Anna Graseck1, Kimberly Roehl1, Anthony Odibo1, George Macones1, Alison Cahill1 1 Washington University in St. Louis, Obstetrics and Gynecology, St. Louis, MO
OBJECTIVE: Recent work using a contemporary population and modern statistical methods has redefined the rate of cervical dilation in normal labor. However, modern norms for changes in station in labor have not been developed. We developed new norms for fetal descent in labor, and compared the rate of fetal descent among women by parity, and among those in spontaneous and induced labor. STUDY DESIGN: A retrospective cohort study was conducted of consecutive term, vertex singletons from 2004-2008 who delivered vaginally. Extensive data were collected from the medical records, including cervical exams (allowing complete reconstruction of the labor curves) and obstetric and neonatal outcomes. Station was measured on a ⫺3 to ⫹3 scale. A repeated-measures analysis was used to construct average descent curves, stratified by parity and labor type. Interval-censored regression was used to estimate duration of labor, from each level of station to the next, stratified by parity and labor type, and adjusted for race and fetal macrosomia. RESULTS: Of 5,388 consecutive term births, 1,992 (37%) were nulliparous. Sixty-two percent (n ⫽ 3,373) were augmented or induced. Multiparous women had faster fetal descent at all stations except from ⫹2 to ⫹3 station, in both unadjusted and adjusted analyses. Median descent from one station point to another ranged from 0.1 - 1.6 hours, but the 95th percentiles encompassed over 12 hours at the same station in women who eventually achieved vaginal delivery. In stratified analysis of spontaneous and non-spontaneous labor, spontaneous laborers had faster descent. CONCLUSION: Multiparas have faster fetal descent than nulliparas. Women in spontaneous labor also have faster fetal descent compared to those being induced or augmented.
S136
302 Shoulder dystocia maneuvers and neonatal outcomes Anne Holland1, Zachary Rubeo1, Karen Flood1, Mary D’Alton1 1 Columbia University College of Physicians and Surgeons, Obstetrics and Gynecology, New York, NY
OBJECTIVE: There is an increasing trend towards employment of posterior arm delivery as the first line fetal manipulation in the management of shoulder dystocia. We endeavored to correlate neonatal outcomes with internal maneuvers. STUDY DESIGN: This is a retrospective chart review of all cases of shoulder dystocia at a single tertiary care institution from 2007 through 2011. Cases were identified from computerized quality assurance database. Electronic records for both the maternal & neonatal details were systematically reviewed. RESULTS: There were 21,618 deliveries from January 2007 to December 2011 with 236 (1.09%) documented cases of shoulder dystocia (SD) identified. McRoberts, suprapubic pressure or both were the only maneuvers used in 161 cases (68.2%). The posterior arm was the only internal maneuver used in 22 cases (9.3%) and Woods or Rubins were the only internal maneuvers used in 38 cases (16.1%). The posterior arm and either Woods or Rubins maneuvers were used in 15 cases (6.4%). There were no perinatal mortalities or documented cases of hypoxic ischemic encephalopathy. There were 32 cases (13.6%) associated with brachial plexus injuries (BPIs) in the SD cohort, and 3 cases (1.6%) with persistent BPI at one year. In cases where the posterior arm was the only maneuver used, there was 1 case of BPI (4.8%), which subsequently resolved. In comparison, when Rubins or Woods were the only maneuvers used, there were 6 cases of BPI (22.2%) with 3 persisting beyond one year (11.1%). In the evaluation of fetal acidemia, there was no significant difference in arterial or venous cord gas results between maneuvers. CONCLUSION: The posterior arm has gained importance in the management of the shoulder dystocia particularly with respect to increased success and reduction of the head to body interval. We have demonstrated that when compared to other secondary maneuvers, there is also appears to be a reduction in BPI both at delivery and at one year.
American Journal of Obstetrics & Gynecology Supplement to JANUARY 2013
Clinical Obstetrics, Diabetes, Labor, Medical-Surgical-Disease, Physiology/Endocrinology, Prematurity
www.AJOG.org
Cervical dilation and fetal descent curves for nulliparas and multiparas
301 A new standard for fetal descent in labor Anna Graseck1, Kimberly Roehl1, Anthony Odibo1, George Macones1, Alison Cahill1 1 Washington University in St. Louis, Obstetrics and Gynecology, St. Louis, MO
OBJECTIVE: Recent work using a contemporary population and modern statistical methods has redefined the rate of cervical dilation in normal labor. However, modern norms for changes in station in labor have not been developed. We developed new norms for fetal descent in labor, and compared the rate of fetal descent among women by parity, and among those in spontaneous and induced labor. STUDY DESIGN: A retrospective cohort study was conducted of consecutive term, vertex singletons from 2004-2008 who delivered vaginally. Extensive data were collected from the medical records, including cervical exams (allowing complete reconstruction of the labor curves) and obstetric and neonatal outcomes. Station was measured on a ⫺3 to ⫹3 scale. A repeated-measures analysis was used to construct average descent curves, stratified by parity and labor type. Interval-censored regression was used to estimate duration of labor, from each level of station to the next, stratified by parity and labor type, and adjusted for race and fetal macrosomia. RESULTS: Of 5,388 consecutive term births, 1,992 (37%) were nulliparous. Sixty-two percent (n ⫽ 3,373) were augmented or induced. Multiparous women had faster fetal descent at all stations except from ⫹2 to ⫹3 station, in both unadjusted and adjusted analyses. Median descent from one station point to another ranged from 0.1 - 1.6 hours, but the 95th percentiles encompassed over 12 hours at the same station in women who eventually achieved vaginal delivery. In stratified analysis of spontaneous and non-spontaneous labor, spontaneous laborers had faster descent. CONCLUSION: Multiparas have faster fetal descent than nulliparas. Women in spontaneous labor also have faster fetal descent compared to those being induced or augmented.
S136
302 Shoulder dystocia maneuvers and neonatal outcomes Anne Holland1, Zachary Rubeo1, Karen Flood1, Mary D’Alton1 1 Columbia University College of Physicians and Surgeons, Obstetrics and Gynecology, New York, NY
OBJECTIVE: There is an increasing trend towards employment of posterior arm delivery as the first line fetal manipulation in the management of shoulder dystocia. We endeavored to correlate neonatal outcomes with internal maneuvers. STUDY DESIGN: This is a retrospective chart review of all cases of shoulder dystocia at a single tertiary care institution from 2007 through 2011. Cases were identified from computerized quality assurance database. Electronic records for both the maternal & neonatal details were systematically reviewed. RESULTS: There were 21,618 deliveries from January 2007 to December 2011 with 236 (1.09%) documented cases of shoulder dystocia (SD) identified. McRoberts, suprapubic pressure or both were the only maneuvers used in 161 cases (68.2%). The posterior arm was the only internal maneuver used in 22 cases (9.3%) and Woods or Rubins were the only internal maneuvers used in 38 cases (16.1%). The posterior arm and either Woods or Rubins maneuvers were used in 15 cases (6.4%). There were no perinatal mortalities or documented cases of hypoxic ischemic encephalopathy. There were 32 cases (13.6%) associated with brachial plexus injuries (BPIs) in the SD cohort, and 3 cases (1.6%) with persistent BPI at one year. In cases where the posterior arm was the only maneuver used, there was 1 case of BPI (4.8%), which subsequently resolved. In comparison, when Rubins or Woods were the only maneuvers used, there were 6 cases of BPI (22.2%) with 3 persisting beyond one year (11.1%). In the evaluation of fetal acidemia, there was no significant difference in arterial or venous cord gas results between maneuvers. CONCLUSION: The posterior arm has gained importance in the management of the shoulder dystocia particularly with respect to increased success and reduction of the head to body interval. We have demonstrated that when compared to other secondary maneuvers, there is also appears to be a reduction in BPI both at delivery and at one year.
American Journal of Obstetrics & Gynecology Supplement to JANUARY 2013