A six-year retrospective analysis of shoulder dystocia and delivery of the shoulders

Objective: to investigate the diagnosis, incidence and management of shoulder dystocia, Design: retrospective review of all the deliveries between 1988 and 1993 which were coded on the computer data base as 'moderate difficulty with the shoulders' or 'shoulder dystocia'. Setting: a teaching hospital in the south of England. Participants: the study population consisted of 15 658 women who had cephalic vaginal deliveries of babies weighing > 2.5 kg, The sample consisted of the 257 women reported to have moderate difficulty with the shoulders or shoulder dystocia at delivery, Findings: there was a significant fall in the reported incidence of shoulder dystocia during the period under investigation. Eighty-six (1.1%) of the deliveries between 1988 and 1990 were reported to have been complicated by shoulder dystocia, In 1991 a second option was introduced to allow both shoulder dystocia or moderate difficulties with the shoulders to be coded after delivery. Following this change in categorisation, the incidence of shoulder dystocia was reduced to 30 (0.6%) reported cases in 1992-1993, Over the same period the reported incidence of moderate difficulty rose significantly from 29 (1.1%) in 1992 to 60 (2.4%) in 1993 (P < 0.001). Disparity was noted between the experience of practitioners and contemporary definitions of shoulder dystocia and this was highlighted by the number of reported cases of moderate difficulty. In this study practitioners used the term shoulder dystocia in a general sense to describe a range of difficulties encountered with the delivery of the shoulders and they identified many varied manifestations. In comparison, contemporary literature describes shoulder dystocia as a discrete entity. Key conclusions: shoulder dystocia is a complex clinical scenario and perceptions of the incidence may be influenced by alterations in the delivery technique and changes in the diagnosis and documentation. Implications for practice: the application of traction may interfere with the normal mechanisms of labour and the spontaneous birth of the shoulders, whilst increasing the risk of trauma to the baby. It may be unnecessary to use such interventions routinely in the care of normal labouring women.