Shoulder dystocia: a continuing obstetric challenge

Summary

Cases of shoulder dystocia (n = 1430) that occurred at the Maternity Hospital, Kuwait, over 1 1 years, formed the subjects of this retrospective study. The majority of the parturients were indigenous Kuwaitis (61.6 per cent). Primiparae were less likely to have shoulder dystocia at delivery (P < 0.001). Diabetes, short duration of labour and macrosomia were associated with shoulder dystocia (P < 0.01). An increasing incidence of caesarean section was associated with a reduced incidence of shoulder dystocia. Thirty-six per cent of the babies needed resuscitation with an Apgar score less than 7. Erb's palsy occurred in 12.1 per cent, unintentional fracture of the clavicle in 3.7 per cent, and aspiration pneumonia in 1.1 per cent of the babies. The perinatal mortality rate of 294 per 1000 was higher than the 124 per 1000 for the general maternity population of the hospital (P < 0.001).

Shoulder dystocia has continued to pose a challenge in Kuwait. Diabetic screening and counselling, and ultrasonographic monitoring of the fetal weight will reduce the prevalence of macrosomia, and a liberal policy of caesarean section for macrosomic babies is advocated.