Birth injury in a subsequent vaginal delivery among women with a history of shoulder dystocia

Abstract

To examine risk factors for birth injury in a subsequent vaginal delivery among women with a prior delivery complicated by shoulder dystocia. Population-based retrospective cohort study, Washington State (1987-2007). Logistic regression was used to assess risk factors associated with subsequent birth injury. Of 9232 women who met inclusion criteria, 223 (2.4%) had a subsequent vaginal delivery with birth injury. Birth injury in an index delivery, adjusted odds ratio (aOR) 2.6 [95% confidence interval (CI) 1.7-4.1] and factors in subsequent delivery: birth weight ≥4000 g, aOR 4.4 (95% CI: 3.0-6.3), gestational diabetes, aOR 1.9 (95% CI: 1.2-3.2), Hispanic ethnicity aOR 1.9 (95% CI: 1.2-2.9), and maternal obesity, aOR 1.8 (95% CI: 1.3-2.6) were associated with birth injury. Among women with prior delivery complicated by shoulder dystocia, the risk factors identified in this study should be carefully considered prior to deciding upon route of delivery - cesarean vs. vaginal delivery.