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AJP Rep 2015; 05(02): e099-e104
DOI: 10.1055/s-0035-1548544
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Association of Fetal Abdominal–Head Circumference Size Difference With Shoulder Dystocia: A Multicenter Study

Loraine Endres
1   Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Center for Biomedical and Research Informatics, Evanston, Illinois
,
Emily DeFranco
2   Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
,
Theresa Conyac
1   Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Center for Biomedical and Research Informatics, Evanston, Illinois
,
Marci Adams
1   Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Center for Biomedical and Research Informatics, Evanston, Illinois
,
Ying Zhou
1   Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Center for Biomedical and Research Informatics, Evanston, Illinois
,
Kristin Magner
2   Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
,
Luke O'Rourke
3   Department of Obstetrics and Gynecology, Aurora Sinai Medical Center, Milwaukee, Wisconsin
,
Kiley A. Bernhard
3   Department of Obstetrics and Gynecology, Aurora Sinai Medical Center, Milwaukee, Wisconsin
,
Danish Siddiqui
3   Department of Obstetrics and Gynecology, Aurora Sinai Medical Center, Milwaukee, Wisconsin
,
Anna McCormick
4   Department of Obstetrics and Gynecology, Rush University Medical Center, Chicago, Illinois
,
Jacques Abramowicz
4   Department of Obstetrics and Gynecology, Rush University Medical Center, Chicago, Illinois
,
Ronald Merkel
5   Good Samaritan Hospital, Fetal Care Center of Cincinnati, Cincinnati, Ohio
,
Rana Jawish
5   Good Samaritan Hospital, Fetal Care Center of Cincinnati, Cincinnati, Ohio
,
Mounira Habli
5   Good Samaritan Hospital, Fetal Care Center of Cincinnati, Cincinnati, Ohio
,
Alissa Floman
6   Department of Obstetrics and Gynecology, University of Arkansas Medical School, Little Rock, Arkansas
,
Everett F. Magann
6   Department of Obstetrics and Gynecology, University of Arkansas Medical School, Little Rock, Arkansas
,
Suneet P. Chauhan
7   Department of Obstetrics, Gynecology and Reproductive Sciences, Lyndon B. Johnson Hospital, Houston, Texas
,
for the CAOG FAR Research Network › Author Affiliations
Further Information

Publication History

17 October 2014

29 January 2015

Publication Date:
27 April 2015 (online)

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Abstract

Objective This study aims to determine if shoulder dystocia is associated with a difference in the fetal abdominal (AC) to head circumference (HC) of 50 mm or more noted on antenatal ultrasound.

Study Design A multicenter matched case–control study was performed comparing women who had shoulder dystocia to controls who did not. Women with vaginal births of live born nonanomalous singletons ≥ 36 weeks of gestation with an antenatal ultrasound within 4 weeks of delivery were included. Controls were matched for gestational age, route of delivery, and diabetes status.

Results We identified 181 matched pairs. Only 5% of the fetuses had an AC to HC of ≥ 50 mm. The proportion of AC to HC difference of ≥ 50 mm was significantly higher in shoulder dystocia cases (8%) than controls (1%, p = 0.002). With multivariate regression, the three significant factors associated with shoulder dystocia were AC to HC ≥ 50 mm (odds ratio [OR], 7.3; confidence interval [CI], 1.6–33.3; p = 0.010), femur length (OR, 1.1; CI, 1.0–1.2; p = 0.002), and induced labor (OR, 1.8; CI, 1.1–3.1; p = 0.027).

Conclusion A prenatal ultrasound finding of a difference in AC to HC of ≥ 50 mm while uncommon is associated with shoulder dystocia.

Keywords

ultrasound - abdominal circumference - head circumference - shoulder dystocia

Note

The study was an oral presentation at the Central Association of Obstetricians and Gynecologists 2013 Annual Meeting at Napa, California from October 16 to 19, 2013.


Reprints will not be available.


 

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