Increases in the rate of shoulder dystocia
MICHAEL G. ROSS & MARIE H. BEALL
David Geffen School of Medicine at UCLA, Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, CA, USA
We read with interest the article of Dandolu et al. Citation[1] in which the authors suggest that the rate of shoulder dystocia has increased by ten-fold from 1979 to 2003. The authors used a Maryland State database of six successive five-year periods in which the rate of shoulder dystocia reporting increased from 0.2% to 2.11%. Although the authors address issues of the inherent limitations of database coding, and the lack of clear definition for either shoulder dystocia or macrosomia, they conclude in both the abstract and manuscript that there was a steady increase in the rate of shoulder dystocia over the past 24 years. Whereas it is likely that vacuum, forceps, and episiotomy were reasonably well coded, the recognition of shoulder dystocia is far less likely. Even as the database extends through 2003, the authors do not describe the definition currently utilized in their institutions for shoulder dystocia or macrosomia. It would appear that the inclusion of newborn weights and the association of weight with shoulder dystocia in this population would have provided much greater insight into the potential change in shoulder dystocia occurrence. Similarly, the conclusion that the episiotomy does not appear to decrease shoulder dystocia is markedly limited by the inability to determine if the episiotomies were performed prior to or following shoulder dystocia, and the lack of correlation with fetal weight. In view of the marked limitations in the data set, and the lack of any ability to confirm either past or present coding of shoulder dystocia with an objective definition Citation[2], the authors can only conclude that there has been a steady increase in the ‘coding’ of shoulder dystocia over the past 24 years. Conclusions regarding the potential efficacy of episiotomy are unwarranted based upon these data.
Michael G. Ross, MD, MPH
Professor of Obstetrics and Gynecology
and Public Health
David Geffen School of Medicine at UCLA
and UCLA School of Public Health
Chair, Department of Obstetrics and Gynecology
Harbor-UCLA Medical Center, CA, USA
E-mail: [email protected]
Increases in the rate of shoulder dystocia – Reply
VANI DANDOLU
Department of Obstetrics and Gynecology, Temple University Hospital, Philadelphia, PA 19140, USA
Thank you for your interest in our research work. We agree with your comment that lack of newborn birth weights and information regarding whether episiotomy was performed prior to occurrence of dystocia or for the management of dystocia limits the conclusions that can be drawn from this database. However, it is documented in the literature that the newborn birth weight has steadily increased over the past two decades Citation[1], and this probably explains part of the increase in the rate of shoulder dystocia, in addition to the improved ‘coding’. As discussed in the manuscript it is vital to have linkage of databases with maternal and newborn information to derive valid conclusions.
Vani Dandolu, MD
Department of Obstetrics and Gynecology
Temple University Hospital
Philadelphia, PA 19140, USA
E-mail: [email protected]
References
- Dandolu V, Lawrence L, Gaughan J P, Grotegut C, Harmanli O H, Jaspan D, Henandez E. Trends in the rate of shoulder dystocia over two decades. J Matern Fetal Neonatal Med 2005; 18: 305–310
- Spong C Y, Beall M, Rodrigues D, Ross M G. An objective definition of shoulder dystocia: Prolonged head-to-body delivery intervals and/or the use of ancillary obstetric maneuvers. Obstet Gynecol 1995; 86: 433–436
References
- Ananth C V, Wen S W. Trends in fetal growth among singleton gestations in the United States and Canada, 1985 through 1998. Semin Perinat 2002; 26: 260–267