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Abstract
Discussion Forum (0)
Introduction: Shoulder dystocia impacts between 0.2 to 3 percent of vaginal births and is associated with significant maternal and neonatal morbidity. The purpose of this study was to evaluate ultrasound-measured abdominal circumference less head circumference (AC-HC) for the prediction of shoulder dystocia.
Methods: We conducted an IRB approved, multi-center, retrospective review examining term deliveries from July, 2016 to December, 2019. Patients were included if they had a formal ultrasound within fourteen days of delivery. Cutpoint analysis was performed to determine the optimal cutoff to maximize sensitivity and specificity.
Results: There were 1,459 vaginal deliveries meeting the inclusion criteria. The mean birthweight was 3,173g (+/- 501g). Shoulder dystocia occurred in 43 (2.9%) cases. The AC-HC measurement was significantly associated with shoulder dystocia (p < .001). In cutpoint analysis to maximize sensitivity and specificity, AC-HC had an area under the curve of 0.701 with an optimal cutpoint of 25mm. At an AC-HC measurement of 25mm or above, the odds ratio for shoulder dystocia was 5.31 (CI 2.84-9.94).
Conclusion/Implications: At an AC-HC difference of 25mm, there is an increased risk of shoulder dystocia. This knowledge could be used to heighten awareness of risks at the time of delivery to reduce morbidity associated with shoulder dystocia. Future investigations are needed to evaluate this in a prospective manner.
Methods: We conducted an IRB approved, multi-center, retrospective review examining term deliveries from July, 2016 to December, 2019. Patients were included if they had a formal ultrasound within fourteen days of delivery. Cutpoint analysis was performed to determine the optimal cutoff to maximize sensitivity and specificity.
Results: There were 1,459 vaginal deliveries meeting the inclusion criteria. The mean birthweight was 3,173g (+/- 501g). Shoulder dystocia occurred in 43 (2.9%) cases. The AC-HC measurement was significantly associated with shoulder dystocia (p < .001). In cutpoint analysis to maximize sensitivity and specificity, AC-HC had an area under the curve of 0.701 with an optimal cutpoint of 25mm. At an AC-HC measurement of 25mm or above, the odds ratio for shoulder dystocia was 5.31 (CI 2.84-9.94).
Conclusion/Implications: At an AC-HC difference of 25mm, there is an increased risk of shoulder dystocia. This knowledge could be used to heighten awareness of risks at the time of delivery to reduce morbidity associated with shoulder dystocia. Future investigations are needed to evaluate this in a prospective manner.
Introduction: Shoulder dystocia impacts between 0.2 to 3 percent of vaginal births and is associated with significant maternal and neonatal morbidity. The purpose of this study was to evaluate ultrasound-measured abdominal circumference less head circumference (AC-HC) for the prediction of shoulder dystocia.
Methods: We conducted an IRB approved, multi-center, retrospective review examining term deliveries from July, 2016 to December, 2019. Patients were included if they had a formal ultrasound within fourteen days of delivery. Cutpoint analysis was performed to determine the optimal cutoff to maximize sensitivity and specificity.
Results: There were 1,459 vaginal deliveries meeting the inclusion criteria. The mean birthweight was 3,173g (+/- 501g). Shoulder dystocia occurred in 43 (2.9%) cases. The AC-HC measurement was significantly associated with shoulder dystocia (p < .001). In cutpoint analysis to maximize sensitivity and specificity, AC-HC had an area under the curve of 0.701 with an optimal cutpoint of 25mm. At an AC-HC measurement of 25mm or above, the odds ratio for shoulder dystocia was 5.31 (CI 2.84-9.94).
Conclusion/Implications: At an AC-HC difference of 25mm, there is an increased risk of shoulder dystocia. This knowledge could be used to heighten awareness of risks at the time of delivery to reduce morbidity associated with shoulder dystocia. Future investigations are needed to evaluate this in a prospective manner.
Methods: We conducted an IRB approved, multi-center, retrospective review examining term deliveries from July, 2016 to December, 2019. Patients were included if they had a formal ultrasound within fourteen days of delivery. Cutpoint analysis was performed to determine the optimal cutoff to maximize sensitivity and specificity.
Results: There were 1,459 vaginal deliveries meeting the inclusion criteria. The mean birthweight was 3,173g (+/- 501g). Shoulder dystocia occurred in 43 (2.9%) cases. The AC-HC measurement was significantly associated with shoulder dystocia (p < .001). In cutpoint analysis to maximize sensitivity and specificity, AC-HC had an area under the curve of 0.701 with an optimal cutpoint of 25mm. At an AC-HC measurement of 25mm or above, the odds ratio for shoulder dystocia was 5.31 (CI 2.84-9.94).
Conclusion/Implications: At an AC-HC difference of 25mm, there is an increased risk of shoulder dystocia. This knowledge could be used to heighten awareness of risks at the time of delivery to reduce morbidity associated with shoulder dystocia. Future investigations are needed to evaluate this in a prospective manner.
Ultrasound Measured Abdominal Circumference Less Head Circumference and the Association with Shoulder Dystocia
Dr. Meredith Carrel-Lammert
Abstract
Discussion Forum (0)
Introduction: Shoulder dystocia impacts between 0.2 to 3 percent of vaginal births and is associated with significant maternal and neonatal morbidity. The purpose of this study was to evaluate ultrasound-measured abdominal circumference less head circumference (AC-HC) for the prediction of shoulder dystocia.
Methods: We conducted an IRB approved, multi-center, retrospective review examining term deliveries from July, 2016 to December, 2019. Patients were included if they had a formal ultrasound within fourteen days of delivery. Cutpoint analysis was performed to determine the optimal cutoff to maximize sensitivity and specificity.
Results: There were 1,459 vaginal deliveries meeting the inclusion criteria. The mean birthweight was 3,173g (+/- 501g). Shoulder dystocia occurred in 43 (2.9%) cases. The AC-HC measurement was significantly associated with shoulder dystocia (p < .001). In cutpoint analysis to maximize sensitivity and specificity, AC-HC had an area under the curve of 0.701 with an optimal cutpoint of 25mm. At an AC-HC measurement of 25mm or above, the odds ratio for shoulder dystocia was 5.31 (CI 2.84-9.94).
Conclusion/Implications: At an AC-HC difference of 25mm, there is an increased risk of shoulder dystocia. This knowledge could be used to heighten awareness of risks at the time of delivery to reduce morbidity associated with shoulder dystocia. Future investigations are needed to evaluate this in a prospective manner.
Methods: We conducted an IRB approved, multi-center, retrospective review examining term deliveries from July, 2016 to December, 2019. Patients were included if they had a formal ultrasound within fourteen days of delivery. Cutpoint analysis was performed to determine the optimal cutoff to maximize sensitivity and specificity.
Results: There were 1,459 vaginal deliveries meeting the inclusion criteria. The mean birthweight was 3,173g (+/- 501g). Shoulder dystocia occurred in 43 (2.9%) cases. The AC-HC measurement was significantly associated with shoulder dystocia (p < .001). In cutpoint analysis to maximize sensitivity and specificity, AC-HC had an area under the curve of 0.701 with an optimal cutpoint of 25mm. At an AC-HC measurement of 25mm or above, the odds ratio for shoulder dystocia was 5.31 (CI 2.84-9.94).
Conclusion/Implications: At an AC-HC difference of 25mm, there is an increased risk of shoulder dystocia. This knowledge could be used to heighten awareness of risks at the time of delivery to reduce morbidity associated with shoulder dystocia. Future investigations are needed to evaluate this in a prospective manner.
Introduction: Shoulder dystocia impacts between 0.2 to 3 percent of vaginal births and is associated with significant maternal and neonatal morbidity. The purpose of this study was to evaluate ultrasound-measured abdominal circumference less head circumference (AC-HC) for the prediction of shoulder dystocia.
Methods: We conducted an IRB approved, multi-center, retrospective review examining term deliveries from July, 2016 to December, 2019. Patients were included if they had a formal ultrasound within fourteen days of delivery. Cutpoint analysis was performed to determine the optimal cutoff to maximize sensitivity and specificity.
Results: There were 1,459 vaginal deliveries meeting the inclusion criteria. The mean birthweight was 3,173g (+/- 501g). Shoulder dystocia occurred in 43 (2.9%) cases. The AC-HC measurement was significantly associated with shoulder dystocia (p < .001). In cutpoint analysis to maximize sensitivity and specificity, AC-HC had an area under the curve of 0.701 with an optimal cutpoint of 25mm. At an AC-HC measurement of 25mm or above, the odds ratio for shoulder dystocia was 5.31 (CI 2.84-9.94).
Conclusion/Implications: At an AC-HC difference of 25mm, there is an increased risk of shoulder dystocia. This knowledge could be used to heighten awareness of risks at the time of delivery to reduce morbidity associated with shoulder dystocia. Future investigations are needed to evaluate this in a prospective manner.
Methods: We conducted an IRB approved, multi-center, retrospective review examining term deliveries from July, 2016 to December, 2019. Patients were included if they had a formal ultrasound within fourteen days of delivery. Cutpoint analysis was performed to determine the optimal cutoff to maximize sensitivity and specificity.
Results: There were 1,459 vaginal deliveries meeting the inclusion criteria. The mean birthweight was 3,173g (+/- 501g). Shoulder dystocia occurred in 43 (2.9%) cases. The AC-HC measurement was significantly associated with shoulder dystocia (p < .001). In cutpoint analysis to maximize sensitivity and specificity, AC-HC had an area under the curve of 0.701 with an optimal cutpoint of 25mm. At an AC-HC measurement of 25mm or above, the odds ratio for shoulder dystocia was 5.31 (CI 2.84-9.94).
Conclusion/Implications: At an AC-HC difference of 25mm, there is an increased risk of shoulder dystocia. This knowledge could be used to heighten awareness of risks at the time of delivery to reduce morbidity associated with shoulder dystocia. Future investigations are needed to evaluate this in a prospective manner.
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