As you know, most of the time shoulder dystocia is resolved with no injury to the baby. Although it is impossible to predict who will also experience shoulder dystocia with brachial plexus injury (BPI), certain combinations of factors do appear to carry added risk. For example, Mehta et al found that an elevated maternal BMI and fetal weight over 4500g were associated with higher rates of associated BPI when shoulder dystocia does occur (See "Supporting Research and Publications" #1). Gudmundsson et al reported that the presence of a large baby in a short stature mother was associated with a much greater rate of neonatal injury compared to rates with babies of the same size but in tall mother (See #2). Using modern statistical methods others have examined large datasets of cases with BPI and found strong associations with certain combinations of maternal and fetal size (See #s3-5).
Many mothers at term will possess at least one of the risk factors listed in the ACOG Practice Bulletin No. 40 on shoulder dystocia. (See #6) Less than 2% of mothers will meet the standard ACOG estimated fetal weight-based intervention criteria of 5000g or 4500g with maternal diabetes. The average weight of babies with shoulder dystocia is around 4000g or well within the normal range of term birthweights. (See #s7-13) PeriGen’s PeriCALM Shoulder Screen is a four step program that gives you a personalized estimate of a mother’s risk of shoulder dystocia with brachial plexus injury.
Web-based, and easy to use, the PeriCALM Shoulder Screen is designed to help you identify a small subset of women with elevated risk of shoulder dystocia associated with brachial plexus injury (See #12). Based on maternal size and estimated fetal size, PeriCALM Shoulder Screen gives you an estimation of a mother’s personal risk based on her own factors, which in turn facilitates conversations with the mother around choosing method of delivery and documenting informed patient consent.
It is important to remember that this statistical tool is only an estimation of risk based in part on an estimated fetal weight before birth. The exact mechanism of brachial plexus injury in every case is not known and other risk factors may become apparent only during labor. Nevertheless this statistical method does provide a consistent way to consider the imperfect and incomplete information available before labor and enhance your discussion with your patient.
- 1. Mehta SH, Blackwell SC, Bujold E, Sokol RJ.What factors are associated with neonatal injury following shoulder dystocia? J Perinatol 2006;26:85-8. http://www.nature.com/jp/journal/v26/n2/full/7211441a.html
- 2. Gudmundsson S, Henningsson AC, Lindqvist P. Correlation of birth injury with maternal height and birthweight. BJOG 2005;112:764-7. http://www.ncbi.nlm.nih.gov/pubmed/15924534
- 3. Dyachenko A, Ciampi A, Fahey J, Mighty H, Oppenheimer L, Hamilton EF. Prediction of risk for shoulder dystocia with neonatal injury. Am J Obstet Gynecol 2006;195:1544-9. http://www.ncbi.nlm.nih.gov/pubmed/16846585
- 4. Hamilton EF, Ciampi C, Dyachenko A, Lerner HM, Miner L, Sandmire HF. Is shoulder dystocia with brachial plexus injury preventable? Fetal and Maternal Medicine Review 2008;19:293-310. http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=3785928
- 5. Hoffman M , Bailit J, Wilkins I, Gonzalez V, Gregory K, Hatjis C, Ramirez M, Reddy U, Troendle J, Zhang J, Branch W, R Burkman R , VanVeldhusien P, Liu L , Kominiarek M, Hibbard J, Landy H, Haberman S. Predictors of shoulder dystocia with and without neonatal injury using multivariable modeling. Am J Obstet Gynecol 2011:204,S129-S130 http://www.ajog.org/article/S0002-9378%2810%2901591-7/fulltext
- 6. American College of Obstetricians and Gynecologists. Shoulder dystocia. ACOG Practice Bulletin, Number 40. 2002; Washington, DC. http://www.ncbi.nlm.nih.gov/pubmed/12578001
- 7. Ouzounian JG, Gherman RB. Shoulder dystocia: are historic risk factors reliable predictors? Am J Obstet Gynecol 2005;192:1933-5. http://www.ncbi.nlm.nih.gov/pubmed/15970854
- 8. Chauhan SP, Christian B, Gherman RB, Magann EF, Kaluser CK, Morrison JC. Shoulder dystocia without versus with brachial plexus injury: a case-control study. J Matern Fetal Neonatal Med 2007;20:313-7. http://www.ncbi.nlm.nih.gov/pubmed/17437239
- 9. Baskett TF, Allen AC. Perinatal implications of shoulder dystocia. Obstet Gynecol 1995;86:14-7. http://www.ncbi.nlm.nih.gov/pubmed/7784010
- 10. Belfort MA, Dildy GA, Saade GR, Suarez V, Clark SL. Prediction of shoulder dystocia using multivariate analysis. Am J Perinatol 2007;24:5-10. http://www.ncbi.nlm.nih.gov/pubmed/17195152
- 11. Baskett TF. Shoulder dystocia. Best Practice & Research Clin Obstet Gynecol. 2002;6:57–68. http://www.ncbi.nlm.nih.gov/pubmed/11866497
- 12. Mehta SH, Blackwell SC, Hendler I, Bujold E, Sorokin Y, Ager J, Kraemer T, Sokol RJ. Accuracy of estimated fetal weight in shoulder dystocia and neonatal birth injury. Am J Obstet Gynecol 2005;192:1877-80. http://www.ncbi.nlm.nih.gov/pubmed/15970839
- 13. Ginsberg NA, Moisidis C. How to predict recurrent shoulder dystocia. Am J Obstet Gynecol 2001;184:1427-9. http://www.ncbi.nlm.nih.gov/pubmed/11408863
- 14. Bingham J, Chauhan SP, Hayes E, Gherman R, Lewis D. Recurrent shoulder dystocia: a review.Obstet Gynecol Surv. 2010 Mar;65(3):183-8. http://www.ncbi.nlm.nih.gov/pubmed/20214833
PeriGen is an innovative provider of fetal surveillance systems employing patented, pattern-recognition and obstetrics technologies that empower perinatal clinicians to make confident, real-time decisions about the mothers and babies in their care. PeriGen’s customer-centric team of clinicians and technologists builds the most advanced systems available to augment obstetric decision-making and improve communications among the clinical team at the point of care, while supporting data flow between healthcare IT systems.
PeriGen’s unique fetal surveillance products provide dynamic visual cues that direct clinicians to the most essential patient information displayed on the screen. Unlike legacy fetal monitoring devices and software from non-specialist companies, PeriGen Visual Cueing™ provides an instant view of the mother’s and baby’s current status and trends over time to avoid errors, increasing patient safety and reducing risk for clinicians and hospitals.
Most likely, you have come here because one of your patients found information about shoulder dystocia on a PeriGen-sponsored educational site for pregnant women. We trust the information you find here will help identify the small group of mothers who are at increased risk for shoulder dystocia with brachial plexus injury and give you an estimation of that risk based on the mother’s and baby’s size.
- This structured approach helps me identify women at high risk and give a mother an estimate of her risk in addition to my clinical opinion.
Physician insurers recognize the impact PeriGen solutions have on patient safety; particularly in the area of reducing the risk of injury due to shoulder dystocia, and in the use of the Shoulder Screen tool. The patented Shoulder Screen tool is currently used by practicing obstetricians throughout the United States, and promoted by a number of widely- recognized physician insurers including Conventus and MD Advantage.
Robert Goley, SVP of Claims and Risk Management for MD Advantage commented on why the Shoulder Screen Program is successful: “The first step to success…occurred when someone questioned the status quo and was unwilling to accept the assertion that the problem of shoulder dystocia-related injury is insurmountable."