Authors: Nivedita Gauthaman Samuel Walters InAe Tribe Louise Goldsmith Stergios K Doumouchtsis
Publish Date: 2015/10/17
Volume: 27, Issue: 4, Pages: 571-577
Abstract
Shoulder dystocia SD is an obstetric emergency that can be associated with serious neonatal morbidity and mortality The aim of this study was to identify the incidence and risk factors for obstetric anal sphincter injuries OASIS in women who sustained SD at birthThis was a retrospective observational study over a 5year period whereby 403 cases of SD were identified The primary outcome measure was to identify the incidence of OASIS in women with SD We also evaluated the role of the manoeuvres used for the management of SD and aimed to identify possible correlations between specific manoeuvres and OASIS by univariate and multivariate regression analysisShoulder dystocia was associated with a threefold increase in the risk of OASIS in our population The use of internal manoeuvres OR 2182 95 CI 1173–4059 an increased number of manoeuvres ≥4 OR 4667 95 CI 1846–11795 Woods’ screw manoeuvre OR 3096 95 CI 1554–6169 reverse Woods’ screw manoeuvre OR 4848 95 CI 1647–14277 and removal of the posterior arm OR 2222 95 CI 1117–4421 were all associated with a significant increase in the likelihood of OASISIn our study instrumental deliveries the use of internal manoeuvres Woods’ screw and reverse Woods’ screw and four or more manoeuvres for the management of SD were independently associated with a higher incidence of OASIS To effectively manage shoulder dystocia with lower risks of perineal trauma these factors could be considered when designing further prospective studies and developing management protocols
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