Pregnancy week at delivery and the risk of shoulder dystocia: a population study of 2 014 956 deliveries
Article first published online: 10 SEP 2013
© 2013 Royal College of Obstetricians and Gynaecologists
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 121, Issue 1, pages 34–42, January 2014
How to Cite
Pregnancy week at delivery and the risk of shoulder dystocia: a population study of 2 014 956 deliveries. BJOG 2014;121:34–42., , .
- Issue published online: 20 DEC 2013
- Article first published online: 10 SEP 2013
- Manuscript Accepted: 31 MAY 2013
- South-Eastern Norway Regional Health Authority
- pregnancy week;
- risk factor;
- shoulder dystocia
To study whether pregnancy week at delivery is an independent risk factor for shoulder dystocia.
Medical Birth Registry of Norway.
All vaginal deliveries of singleton offspring in cephalic presentation in Norway during 1967 through 2009 (n = 2 014 956).
The incidence of shoulder dystocia was calculated according to pregnancy week at delivery. The associations of pregnancy week at delivery with shoulder dystocia were estimated as crude and adjusted odds ratios using logistic regression analyses. We repeated the analyses in pregnancies with and without maternal diabetes.
Main outcome measures
Shoulder dystocia at delivery.
The overall incidence of shoulder dystocia was 0.73% (n = 14 820), and the incidence increased by increasing pregnancy week at delivery. Birthweight was strongly associated with shoulder dystocia. After adjustment for birthweight, induction of labour, use of epidural analgesia at delivery, prolonged labour, forceps-assisted and vacuum-assisted delivery, parity, period of delivery and maternal age in multivariable analyses, the adjusted odds ratios for shoulder dystocia were 1.77 (1.42–2.20) for deliveries at 32–35 weeks of gestation, and 0.84 (0.79–0.88) at 42–43 weeks of gestation, using weeks 40–41 as the reference. In pregnancies affected by diabetes (n = 11 188), the incidence of shoulder dystocia was 3.95%, and after adjustment for birthweight the adjusted odds ratio for shoulder dystocia was 2.92 (95% CI 1.54–5.52) for deliveries at weeks 32–35 of gestation, and 0.91 (95% CI 0.50–1.66) at 42–43 weeks of gestation.
The risk of shoulder dystocia was associated with increased birthweight, diabetes, induction of labour, use of epidural analgesia at delivery, prolonged labour, forceps-assisted and vacuum-assisted delivery, parity and period of delivery but not with post-term delivery.