Abstract
A sensitive prediction model to aid the identification of women at risk of shoulder dystocia has remained elusive thus far. A proprietary tool known as the PeriCALM Shoulder Screen (PeriGen, Princeton, NJ) has been suggested in observational data to identify at-risk patients through a composite of historical, demographic, and medical factors. This study sought to investigate the effects of routine use of the Shoulder Screen in a community hospital. This was a retrospective review of all deliveries from January 2012 through December 2012 at a residency-affiliated community hospital. The Shoulder Screen has been routinely performed by nearly half of the providers delivering at this hospital since 2011. Analysis was limited to pregnancies of at least 36 weeks' gestation and eligible for vertex vaginal delivery. Of 1,793 eligible pregnancies, 738 (41%) underwent the screening process. Those screened were younger, be of non-white race, and have a higher BMI. The odds of shoulder dystocia were similar between women in the screened and unscreened groups (2.57% vs 2.56%; odds ratio, 0.96; 95% CI: 0.52-1.77). The rates of cesarean delivery (23.3% vs 24.5%, P = 0.38), operative vaginal delivery (4.3% vs 5.6%, P = 0.23), brachial-plexus injury (0.27% vs 0%, P = 0.09), admission to the neonatal intensive-care unit (8.7% vs 8.8%, P = 0.92), and low five-minute Apgar scores (0.41% vs 0.28%, P = 0.66) were also similar. There were statistically significantly decreased incidences of episiotomy (4.5% vs 8.1%, P = 0.003) and severe perineal laceration (1.1% vs 2.6%, P = 0.026) in the unscreened group as well as an increased risk of neonatal clavicular or humeral fracture (0.41% vs 0%, P = 0.038). Use of the Shoulder Screen, while not affecting the cesarean rate, did not reduce the incidence of shoulder dystocia. The differences in maternal and neonatal outcomes may be attributed to the effect of screening or variations in provider practice.
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