Does knowledge of prior shoulder dystocia affect management and outcome of subsequent deliveries?

Abstract

OUTCOME OF SUBSEQUENT DELIVERIES? EDITH GUREWITSCH, ELLEN LANDSBERGER, ANJALI JAIN, STEPHANIE CHA, TARA JOHNSON, ROBERT ALLEN, Johns Hopkins University, Gynecology and Obstetrics, Baltimore, Maryland, Albert Einstein College of Medicine, Obstetrics and Gynecolgy, Bronx, New York, Johns Hopkins University, Biomedical Engineering, Baltimore, Maryland, Johns Hopkins University, Baltimore, Maryland OBJECTIVE: We sought to determine whether clinicians’ awareness of a woman’s prior shoulder dystocia (SD) affects management and outcome of her subsequent delivery. STUDY DESIGN: With IRB approval, records of all women with SD delivery (SDD) at Johns Hopkins Hospital from 6/1993-5/2004 who had at least 1 subsequent live birth at the same institution were reviewed for clinician cognizance of prior SD (as determined by specific documentation in admission or progress notes of subsequent delivery), allowance of a trial of labor (TOL), induction or augmentation of labor, attempted operative vaginal delivery (OpVD), subsequent delivery mode, SD recurrence and brachial plexus injury (BPI) occurrence. Using c and Fisher’s exact test, we compared subsequent deliveries with knowledge of prior SD to those with no knowledge (P!0.05 significant). RESULTS: 78 women met study criteria; 28% were associated with BPI. Knowledge of prior SD was recorded in only 13 (17%) and correlated with payor status and injury at the original SDD. We saw no differences in gestational age, BMI, diabetes or birth weight between groups. Despite elective cesarean without TOL if prior SD was known, SD recurred 9 (12%) times with similar frequency in both groups (table). CONCLUSION: Knowledge of prior SD affects both management and outcome of subsequent delivery. Elective cesarean without TOL does not affect SD recurrence; however, injury may be more likely when prior SD is unknown. Women should be informed of SD, even without clinical sequelae.