1
|
Levin G, Meyer R, Cahan T, Shai D, Tsur A. Shoulder dystocia in deliveries of neonates <3500 grams. Int J Gynaecol Obstet 2024; 165:282-287. [PMID: 37864450 DOI: 10.1002/ijgo.15204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVES To study risk factors for shoulder dystocia (ShD) among women delivering <3500 g newborn. METHODS A retrospective case-control study of all term live-singleton deliveries during 2011-2019. Women with neonatal birthweight <3500 g were included. We compared cases of ShD to other deliveries by univariate and multivariable regression. RESULTS There were 79/41 092 (0.19%) cases of ShD among neonates <3500 g. In multivariable regression analysis, the following factors were independently associated with ShD; operative vaginal delivery (odds ratio [OR] 2.78; 95% confidence interval [CI]: 1.28-6.02, P = 0.009), vaginal birth after cesarean (VBAC, OR 2.74; 1.22-6.13, P = 0.010), sonographic abdominal circumference to biparietal diameter ratio (3.73 among ShD vs. 3.62, OR 1.35; 95% CI: 1.12-1.63, P = 0.001) and sonographic abdominal circumference to head circumference ratio (1.036 among ShD vs. 1.011, OR 3.04; 95% CI: 1.006-9.23, P = 0.049). CONCLUSIONS There is an association between operative vaginal delivery and ShD also in deliveries <3500 g. Importantly, the proportions between the fetal head and abdominal circumference are a better predictor of ShD than the newborn fetal weight and VBAC is associated with ShD.
Collapse
Affiliation(s)
- Gabriel Levin
- The Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Raanan Meyer
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tal Cahan
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniel Shai
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Abraham Tsur
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
2
|
Moscovici K, Wainstock T, Sheiner E, Pariente G. The association between family history of diabetes mellitus and offspring long-term neurological hospitalisation. Acta Paediatr 2020; 109:1236-1242. [PMID: 31677301 DOI: 10.1111/apa.15078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/08/2019] [Accepted: 10/29/2019] [Indexed: 01/27/2023]
Abstract
AIM The aim of the present study was to determine whether being born to non-diabetic mother with a family history of diabetes mellitus (DM) is associated with higher rates of long-term neurological hospitalisations of the offspring. METHODS A retrospective analysis of all live births and paediatric hospitalisations at Soroka University Medical Center between 1991 and 2014 was performed. Family history of DM was collected from prepartum women using anamnesis. During the study period, 208 728 deliveries met the inclusion criteria, and of them 8.2% (n = 17 040) were of non-diabetic mothers with family history of DM. Rates of neurological hospitalisation with or without family history were analysed. RESULTS Offspring born to non-diabetic mothers with family history of DM had higher rates of neurological hospitalisations. The cumulative incidence of long-term neurological hospitalisations was higher as compared with those without family history of DM (log-rank test P = .007). Neurological hospitalisations was higher by 13% in the study group, after controlling for confounders such as maternal age, maternal obesity, hypertensive disorders, birth weight and caesarean delivery. (adjusted odds ratio 1.13, 95% confidence interval 1.04-1.23). CONCLUSION Being born to a non-diabetic mother with a family history of DM is independently associated with higher long-term neurological hospitalisations of the offspring.
Collapse
Affiliation(s)
- Khen Moscovici
- Department of Obstetrics and Gynecology Soroka University Medical Center Ben‐Gurion University of the Negev Beer‐Sheva Israel
| | - Tamar Wainstock
- Department of Public Health Faculty of Health Sciences Ben‐Gurion University of the Negev Beer‐Sheva Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology Soroka University Medical Center Ben‐Gurion University of the Negev Beer‐Sheva Israel
| | - Gali Pariente
- Department of Obstetrics and Gynecology Soroka University Medical Center Ben‐Gurion University of the Negev Beer‐Sheva Israel
| |
Collapse
|
3
|
Shmueli A, Salman L, Hadar E, Aviram A, Bardin R, Ashwal E, Gabbay-Benziv R. Sonographic prediction of macrosomia in pregnancies complicated by maternal diabetes: finding the best formula. Arch Gynecol Obstet 2018; 299:97-103. [PMID: 30327863 DOI: 10.1007/s00404-018-4934-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/04/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the best performing formula for macrosomia prediction in pregnancies complicated by diabetes. METHODS A retrospective analysis was performed of 1060 sonographic fetal biometrical measurements performed within 7 days of delivery in term pregnancies (37-42 gestational weeks) complicated by diabetes. Sonographic prediction of macrosomia (≥ 4000, ≥ 4250, and ≥ 4500 g) was evaluated utilizing ten previously published formulas by: (1) calculating for each macrosomia threshold the sensitivity, specificity, positive and negative predictive value, and ± likelihood ratio for macrosomia prediction; (2) comparing the systematic and random error and the proportion of estimates < 10% of birth weights between macrosomic and non-macrosomic neonates. Best performing formula was determined based on Euclidean distance. RESULTS 97 (9.2%) macrosomic neonates (> 4000 g) were included. Median birth weight was 3380 (1866-3998) g for non-macrosomic and 4198 (4000-5180) g for macrosomic neonates. Higher macrosomia cutoff was associated with higher specificity and lower sensitivity. We found a considerable variation between formulas in different accuracy parameters. Hadlock's formula (1985), based on abdominal circumference, femur length, head circumference and biparietal diameter, had the shortest Euclidean distance, reflecting the highest accuracy. CONCLUSION Prediction of macrosomia among women with diabetes differs significantly between formulas. In our cohort, the best performing formula for macrosomia prediction was Hadlock's formula (1985).
Collapse
Affiliation(s)
- Anat Shmueli
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, 49100, Israel.
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Lina Salman
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, 49100, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Hadar
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, 49100, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Aviram
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ron Bardin
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, 49100, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Ashwal
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Rinat Gabbay-Benziv
- Hillel Yaffe Medical Center, Hadera, Israel
- The Rappaport Faculty of Medicine, Technion, Haifa, Israel
| |
Collapse
|
4
|
Yeagle KP, O'Brien JM, Curtin WM, Ural SH. Are gestational and type II diabetes mellitus associated with the Apgar scores of full-term neonates? Int J Womens Health 2018; 10:603-607. [PMID: 30323688 PMCID: PMC6181089 DOI: 10.2147/ijwh.s170090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To compare Apgar scores of full-term newborns of mothers with gestational (GDM) or type II diabetes mellitus (T2DM) with scores of newborns of mothers without impaired glucose tolerance. Study design This was a retrospective data collection study (n=297). We reviewed 1-minute and 5-minute neonatal Apgar scores of newborns of mothers with GDM (n=100) or T2DM (n=97). Our control group consisted of newborns of mothers without a prior history of impaired glucose tolerance (n=100). ANOVA and linear model with corrected errors were used and adjusted for newborn sex and weight, and maternal age. Chi-squared analysis was performed for newborn sex. Results The mean 1-minute and 5-minute Apgar scores were 7.8 and 8.9 for the GDM group and 7.7 and 8.9 for the T2DM group, respectively. There was no statistical difference in the 1-minute and 5-minute Apgar scores between the GDM group and controls (P=0.89 and P=0.13, respectively) nor in the scores between the T2DM group and controls (P=0.67 and P=0.40, respectively). Conclusion Maternal history of GDM and T2DM does not appear to be associated with the 1-minute and 5-minute Apgar scores of full-term newborns of mothers with GDM and T2DM as compared to newborns of mothers without a history of impaired glucose tolerance.
Collapse
Affiliation(s)
- Kevin P Yeagle
- Penn State Hershey, Department of the College of Medicine, Hershey, PA, USA,
| | - James Michael O'Brien
- Penn State Hershey Obstetrics and Gynecology, Department of Maternal Fetal Medicine, Hershey, PA, USA
| | - William M Curtin
- Penn State Hershey Obstetrics and Gynecology, Department of Maternal Fetal Medicine, Hershey, PA, USA
| | - Serdar H Ural
- Penn State Hershey Obstetrics and Gynecology, Department of Maternal Fetal Medicine, Hershey, PA, USA
| |
Collapse
|
5
|
Kleitman V, Feldman R, Walfisch A, Toledano R, Sheiner E. Recurrent shoulder dystocia: is it predictable? Arch Gynecol Obstet 2016; 294:1161-1166. [DOI: 10.1007/s00404-016-4139-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/10/2016] [Indexed: 01/20/2023]
|
6
|
Atia HC, Koren Y, Weintraub AY, Novack L, Sheiner E. Is a value of over 200 mg/dL in the oral glucose tolerance test, a marker of severity in patients with gestational diabetes mellitus? J Matern Fetal Neonatal Med 2013; 26:1259-62. [DOI: 10.3109/14767058.2013.777421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
7
|
Tsur A, Sergienko R, Wiznitzer A, Zlotnik A, Sheiner E. Critical analysis of risk factors for shoulder dystocia. Arch Gynecol Obstet 2011; 285:1225-9. [PMID: 22083313 DOI: 10.1007/s00404-011-2139-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 11/02/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The study was aimed to define trends, risk factors and perinatal outcome associated with shoulder dystocia (SD). METHODS A population-based study comparing all singleton deliveries with and without SD was conducted. Statistical analysis was performed using multiple logistic regression analysis. RESULTS Shoulder dystocia complicated 0.2% (n = 451) of all deliveries included in the study (n = 240,189). The rate of SD declined from 0.4% in 1988 to 0.13% in 2009. Independent risk factors for SD in a multivariable analysis were fetal macrosomia (birth-weight ≥ 4 kg; OR = 16.1; 95% CI 13.2-19.6, P < 0.001), failure of labor to progress during the second stage (OR = 2.4; 95% CI 1.5-3.7, P < 0.001), diabetes mellitus (OR = 1.8; 95% CI 1.4-2.3, P < 0.001) and advanced maternal age (years, OR = 1.02; 95% CI 1.001-1.03, P = 0.029). Perinatal mortality was significantly higher after SD as compared to the comparison group (6.2 vs. 1.4%, P <0.001). Another multivariable analysis, with perinatal mortality as the outcome variable, controlling for confounders such as maternal age, gestational age, diabetes mellitus, etc. was constructed; SD was noted as an independent risk factor for perinatal mortality (adjusted OR = 11.1; 95% CI 7.2-17.1, P < 0.001). CONCLUSIONS Shoulder dystocia, associated with macrosomia, labor dystocia, diabetes mellitus, and advanced maternal age, is an independent risk factor for perinatal mortality. In an era of increased rate of cesarean deliveries, and perhaps increased accuracy of birth weight estimation, the rate of shoulder dystocia gradually declines.
Collapse
Affiliation(s)
- Avishai Tsur
- The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | | | | | | | | |
Collapse
|
8
|
Risk factors for recurrent shoulder dystocia, Washington state, 1987-2004. Am J Obstet Gynecol 2008; 198:e16-24. [PMID: 18279836 DOI: 10.1016/j.ajog.2007.09.050] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2007] [Revised: 08/23/2007] [Accepted: 09/26/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of the study was to identify recurrent shoulder dystocia risk factors. STUDY DESIGN This was a population-based case-control study in Washington state (1987-2004). Primary and recurrent shoulder dystocia incidences were calculated. Logistic regression was used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for subsequent shoulder dystocia risk factors. RESULTS Primary and recurrent shoulder dystocia annual incidences were 2.3 of 100 and 13.5 of 100. Of 26,208 women with shoulder dystocia deliveries, 8991 had subsequent vaginal births, and of those, 1060 (11.8%) had a recurrent shoulder dystocia. Index pregnancy birthweight was associated with an increased risk of subsequent shoulder dystocia: 3500-3999 g, aOR 1.8 (95% CI 1.5 to 2.3); 4000-4499 g, aOR 3.3 (95% CI 2.6 to 4.1); 4500-4999 g, aOR 3.1 (95% CI 2.3 to 4.3); and 5000 g or greater, aOR 3.8 (95% CI 2.0 to 7.3). Vacuum delivery, aOR 1.4 (95% CI 1.2 to 1.7), and severe shoulder dystocia, aOR 2.1 (95% CI 1.6 to 2.7) in the index delivery, were also significant. CONCLUSION Birthweight of 3500 g or greater, vacuum delivery, or severe shoulder dystocia in the index delivery were independent risk factors for shoulder dystocia recurrence.
Collapse
|
9
|
Brimacombe M, Iffy L, Apuzzio JJ, Varadi V, Nagy B, Raju V, Portuondo N. Shoulder dystocia related fetal neurological injuries: the predisposing roles of forceps and ventouse extractions. Arch Gynecol Obstet 2007; 277:415-22. [PMID: 17906870 DOI: 10.1007/s00404-007-0465-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Accepted: 08/30/2007] [Indexed: 02/04/2023]
Abstract
On the basis of 333 documented cases of permanent perinatal neurological damage, associated with arrest of the shoulders at birth, the authors conducted a retrospective study in order to evaluate the predisposing role, if any, of the utilization of extraction instruments. The investigation revealed that 35% of all injuries occurred in neonates delivered by forceps, ventouse or sequential ventouse-forceps procedures. This frequency was several-fold higher than the prevailing instrument use in the practices of American obstetricians during the same years. A high rate of forceps and ventouse extractions was demonstrable in all birth weight categories. Average weight and moderately large for gestational age fetuses underwent instrumental extractions more often than grossly macrosomic ones. This circumstance indicates that forceps and ventouse are independent risk factors, unrelated to fetal size. Their use entailed central nervous system injuries significantly more often than did spontaneous deliveries. The findings suggest that extraction procedures may be as important as macrosomia among the factors that lead to neurological damage in the child in connection with shoulder dystocia. Because they augment the intrinsic dangers of excessive fetal size exponentially, the authors consider their use in case of > or =4,000 g estimated fetal weight inadvisable. Sequential forceps-ventouse utilization further doubles the risks and is, therefore, to be avoided in all circumstances.
Collapse
Affiliation(s)
- Michael Brimacombe
- Department of Preventive Medicine, UMDNJ, New Jersey Medical School, Newark, NJ, USA.
| | | | | | | | | | | | | |
Collapse
|
10
|
Sheiner E. The relationship between fetal gender and pregnancy outcome. Arch Gynecol Obstet 2007; 275:317-9. [PMID: 17342496 DOI: 10.1007/s00404-007-0341-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Accepted: 02/13/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Genesis 3:16 is the passage usually quoted by those who believe women have been cursed to give birth in pain. God punished Eve that she will have increased (painful) labor, after she was beguiled by the serpent and ate the forbidden fruit of knowledge. The Lord God said "I will greatly multiply your pain in childbearing; in pain you shall bring forth children". Nevertheless, the word translated as "children" is the Hebrew word "banim" which means "boys". Indeed, most interpreters translated boys as children. Yet, there is gaining scientific evidence that the gender does matter. OBJECTIVE The present Editorial will discuss gender differences in perinatal medicine. CONCLUSIONS Male gender is an independent risk factor for adverse pregnancy outcome. Further research including endocrine and immunological tests is needed to clarify gender differences in birth outcome.
Collapse
Affiliation(s)
- Eyal Sheiner
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, P.O. Box 151, Beer-Sheva 84101, Israel.
| |
Collapse
|