The association of vacuum-assisted delivery and shoulder dystocia among macrosomic newborns: a retrospective study

Abstract

Purpose

Although shoulder dystocia (ShD) is associated with fetal macrosomia and vacuum-assisted delivery (VAD), the independent role of the latter in the occurrence of ShD is yet to be completely elucidated, as it is difficult to study its true independent contribution to ShD formation in the presence of many confounding factors. Therefore, we aimed to study whether VAD is independently associated with an increased risk for ShD among macrosomic newborns.

Methods

A retrospective cohort study from a single tertiary medical center including all women who delivered vaginally a macrosomic infant during 2011–2020. We allocated the study cohort into two groups: (1) VAD (2) spontaneous vaginal deliverys, and analyzed risk factors for ShD. A multivariate regression analysis was performed to identify determinants independently associated with ShD occurrence.

Results

Of 2,664 deliveries who met the study inclusion criteria, 118 (4.4%) were VAD. The rate of ShD in the entire cohort was 108/2664 (4.1%). The following factors were more frequent among the VAD group: no previous vaginal delivery [odds ratio (OR) 2.4 (95% confidence interval (CI) 1.4–4.0, p < 0.001)], prolonged second stage (OR 11.9; 95% CI 8.1–17.6, p < 0.01), induction of labor (OR 2.4; 95% CI 1.5–3.8, p < 0.01) and ShD (OR 2.0; 95% CI 1.0–4.1, p = 0.04). ShD was associated with higher rates of maternal height < 160 cm (OR 2.0; 95% CI 1.3–3.1, p < 0.01), pregestational diabetes (OR 7.2; 95% CI 2.0–26.8, p = 0.01), hypertensive disorder (OR 2.6; 95% CI 1.1–6.2, p = 0.02) and higher birthweight (mean 4,124 vs. 4,167 g, p < 0.01). On multivariate regression analysis, the following factors remained independently associated with ShD occurrence: increased birthweight (aOR 1.0; 95% CI 1.0–1.0, p < 0.01), pregestational diabetes (aOR 5.3; 95% CI 1.1–25.0, p = 0.03), while maternal height was negatively associated with ShD (aOR 0.9; 95% CI 0.9–0.9, p < 0.01).

Conclusion

In deliveries of neonates above 4000 g, VAD did not independently increase the risk of ShD occurrence. Therefore, when expeditious delivery of a macrosomic infant is required, VAD is a viable option.

This is a preview of subscription content, access via your institution.

Fig. 1

Abbreviations

ShD:

Shoulder dystocia

VAD:

Vacuum-assisted delivery

References

  1. 1.

    Bulletins—Obstetrics CoP (2017) Practice bulletin No 178: shoulder dystocia. ObstetGynecol 129(5):e123–e133

    Google Scholar 

  2. 2.

    Gherman RB, Chauhan SP, Lewis DF (2012) A survey of central association members about the definition, management, and complications of shoulder dystocia. ObstetGynecol 119(4):830–837

    Google Scholar 

  3. 3.

    Nesbitt TS, Gilbert WM, Herrchen B (1998) Shoulder dystocia and associated risk factors with macrosomic infants born in California. Am J ObstetGynecol 179(2):476–480

    CAS  Article  Google Scholar 

  4. 4.

    Mehta SH, Bujold E, Blackwell SC, Sorokin Y, Sokol RJ (2004) Is abnormal labor associated with shoulder dystocia in nulliparous women? Am J Obstet Gynecol. 190(6):1604–1607

    Article  Google Scholar 

  5. 5.

    Hansen A, Chauhan SP (2014) Shoulder dystocia: definitions and incidence. SeminPerinatol 38(4):184–188

    Google Scholar 

  6. 6.

    Dall’Asta A, Ghi T, Pedrazzi G, Frusca T (2016) Does vacuum delivery carry a higher risk of shoulder dystocia? Review and meta-analysis of the literature. Eur J ObstetGynecolReprodBiol 204:62–68

    Google Scholar 

  7. 7.

    Levin G, Meyer R, Yagel S, David M, Yinon Y, Rottenstreich A (2020) Which way is better to deliver the very heavy baby: mode of delivery, maternal and neonatal outcome. Arch GynecolObstet 3:2–23

    Google Scholar 

  8. 8.

    Vidarsdottir H, Geirsson RT, Hardardottir H, Valdimarsdottir U, Dagbjartsson A (2011) Obstetric and neonatal risks among extremely macrosomic babies and their mothers. Am J ObstetGynecol 204(5):423.e1–6

    Article  Google Scholar 

  9. 9.

    Tsur A, Batsry L, Toussia-Cohen S, Rosenstein MG, Barak O, Brezinov Y et al (2019) Development and validation of a machine learning model for prediction of shoulder dystocia. Ultrasound ObstetGynecol 2:110–129

    Google Scholar 

  10. 10.

    Sheiner E, Levy A, Hershkovitz R, Hallak M, Hammel RD, Katz M et al (2006) Determining factors associated with shoulder dystocia: a population-based study. Eur J ObstetGynecolReprodBiol 126(1):11–15

    Google Scholar 

  11. 11.

    Kolderup LB, Laros RK, Musci TJ (1997) Incidence of persistent birth injury in macrosomic infants: association with mode of delivery. Am J ObstetGynecol 177(1):37–41

    CAS  Article  Google Scholar 

  12. 12.

    Herzberg S, Kabiri D, Mordechai T, Haj Yahya R, Chill H, Levitt L et al (2017) Fetalmacrosomia as a risk factor for shoulder dystocia during vacuum extraction. J MaternFetal Neonatal Med 30(15):1870–1873

    Article  Google Scholar 

  13. 13.

    Cheng YW, Norwitz ER, Caughey AB (2006) The relationship of fetal position and ethnicity with shoulder dystocia and birth injury. Am J ObstetGynecol 195(3):856–862

    Article  Google Scholar 

  14. 14.

    Revicky V, Mukhopadhyay S, Morris EP, Nieto JJ (2012) Can we predict shoulder dystocia? Arch GynecolObstet 285(2):291–295

    Google Scholar 

  15. 15

    Overland EA, Vatten LJ, Eskild A (2012) Risk of shoulder dystocia: associations with parity and offspring birthweight. A population study of 1 914 544 deliveries. ActaObstetGynecol Scand. 91(4):483–488

    Article  Google Scholar 

  16. 16.

    Carpenter MW, Coustan DR (1982) Criteria for screening tests for gestational diabetes. Am J ObstetGynecol 144(7):768–773

    CAS  Article  Google Scholar 

  17. 17.

    Salomon LJ, Alfirevic Z, Da Silva CF, Deter RL, Figueras F, Ghi T et al (2019) ISUOG practice guidelines: ultrasound assessment of fetal biometry and growth. Ultrasound ObstetGynecol 53(6):715–723

    CAS  Google Scholar 

  18. 18

    Hadlock FP, Harrist RB, Carpenter RJ, Deter RL, Park SK (1984) Sonographic estimation of fetal weight. The value of femur length in addition to head and abdomen measurements. Radiology 150(2):535–540

    CAS  Article  Google Scholar 

  19. 19.

    Chauhan SP, Laye MR, Lutgendorf M, McBurney JW, Keiser SD, Magann EF et al (2014) A multicenter assessment of 1,177 cases of shoulder dystocia: lessons learned. Am J Perinatol 31(5):401–406

    Article  Google Scholar 

  20. 20.

    Belfort MA, Dildy GA, Saade GR, Suarez V, Clark SL (2007) Prediction of shoulder dystocia using multivariate analysis. Am J Perinatol 24(1):5–10

    Article  Google Scholar 

  21. 21.

    Åberg K, Norman M, Pettersson K, Ekéus C (2016) Vacuum extraction in fetalmacrosomia and risk of neonatal complications: a population-based cohort study. ActaObstetGynecolScand 95(10):1089–1096

    Google Scholar 

  22. 22.

    Overland EA, Spydslaug A, Nielsen CS, Eskild A (2009) Risk of shoulder dystocia in second delivery: does a history of shoulder dystocia matter? Am J ObstetGynecol 200(5):506.e1–6

    Article  Google Scholar 

  23. 23.

    Gudmundsson S, Henningsson AC, Lindqvist P (2005) Correlation of birth injury with maternal height and birthweight. BJOG 112(6):764–767

    Article  Google Scholar 

  24. 24.

    Mazouni C, Porcu G, Cohen-Solal E, Heckenroth H, Guidicelli B, Bonnier P et al (2006) Maternal and anthropomorphic risk factors for shoulder dystocia. ActaObstetGynecolScand 85(5):567–570

    Google Scholar 

  25. 25

    ACOG (2017) Practice, bulletin, No, 178 shoulder dystocia. ObstetGynecol 129(5):e123–e133

    Google Scholar 

  26. 26.

    Levy A, Sheiner E, Hammel RD, Hershkovitz R, Hallak M, Katz M et al (2006) Shoulder dystocia: a comparison of patients with and without diabetes mellitus. Arch GynecolObstet 273(4):203–206

    Google Scholar 

  27. 27.

    Malinowska-Polubiec A, Romejko-Wolniewicz E, Szostak O, Dobrowolska-Redo A, Tolloczko J, Zareba-Szczudlik J et al (2014) Shoulder dystocia in diabetic and non-diabetic pregnancies. NeuroEndocrinolLett 35(8):733–740

    Google Scholar 

  28. 28.

    Secher AL, Bytoft B, Tabor A, Damm P, Mathiesen ER (2015) Fetalsonographic characteristics associated with shoulder dystocia in pregnancies of women with type 1 diabetes. ActaObstetGynecolScand 94(10):1105–1111

    CAS  Google Scholar 

Download references

Funding

No external funding was used in this conduct of this study.

Author information

Affiliations

Authors

Contributions

All authors contributed to the manuscript. GL, RM, and AT reviewed the literature and wrote the paper. AR, DS, TC, and DS performed the procedures and collected the data. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Gabriel Levin.

Ethics declarations

Conflict of interest

Authors declare that they have no conflict of interest.

Human and animal rights

For this type of study, formal consent is not required and was waived by the institutional review board approval (The study was approved by the Sheba Medical Center Committee for Human Subjects Research (IRB number 5503–18-SMC, 28/10/2018).

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOC 40 KB)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Levin, G., Tsur, A., Rottenstreich, A. et al. The association of vacuum-assisted delivery and shoulder dystocia among macrosomic newborns: a retrospective study. Arch Gynecol Obstet (2021). https://doi.org/10.1007/s00404-020-05941-4

Download citation

Keywords

  • Birthweight
  • Macrosomia
  • Risk factors
  • Shoulder dystocia
  • Vacuum
  • Operative delivery