From the Research
The risk of recurrent shoulder dystocia in a pregnant woman with a history of prior shoulder dystocia is approximately 7.2%, with a six-fold increased risk compared to women without a prior history of shoulder dystocia. This represents a significant increase compared to the general population risk of 0.6-1.4% 1. Women with a history of shoulder dystocia should be counseled about this increased risk during prenatal care. Several factors can further elevate this risk, including:
- Low maternal height
- Birthweight >4000 g
- Positive fetal weight difference exceeding 250 g from index to subsequent delivery
- Stimulation with oxytocin
- Operative vaginal delivery Management options include consideration of elective cesarean delivery, particularly if additional risk factors are present or if the estimated fetal weight exceeds 4500 grams. Close monitoring of fetal growth through ultrasound in the third trimester is recommended 1. The recurrence risk is related to persistent maternal pelvic anatomy combined with similar or increased fetal size in subsequent pregnancies. While not all cases of recurrent shoulder dystocia can be predicted or prevented, awareness of this risk allows for appropriate planning and preparation of the delivery team should shoulder dystocia occur again.
Key points to consider in the management of women with a history of shoulder dystocia include:
- The importance of individualized management strategies to minimize recurrence and associated morbidities
- The need for careful monitoring of fetal growth and birthweight
- The consideration of elective cesarean delivery in high-risk cases
- The importance of training and simulation exercises to improve physician and team performance in the event of shoulder dystocia 2.