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Risk assessment of shoulder dystocia via the difference between transverse abdominal and biparietal diameters: A retrospective observational cohort study

Shoulder dystocia is defined as vaginal cephalic delivery that requires additional obstetric maneuvers to deliver the fetus after the head has been delivered and gentle traction has failed. A bigger difference between the transverse abdominal diameter (TAD) (abdominal circumference [AC]/π) and bipar...

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Autores principales: Shinohara, Satoshi, Okuda, Yasuhiko, Hirata, Shuji
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880486/
https://www.ncbi.nlm.nih.gov/pubmed/33577577
http://dx.doi.org/10.1371/journal.pone.0247077
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author Shinohara, Satoshi
Okuda, Yasuhiko
Hirata, Shuji
author_facet Shinohara, Satoshi
Okuda, Yasuhiko
Hirata, Shuji
author_sort Shinohara, Satoshi
collection PubMed
description Shoulder dystocia is defined as vaginal cephalic delivery that requires additional obstetric maneuvers to deliver the fetus after the head has been delivered and gentle traction has failed. A bigger difference between the transverse abdominal diameter (TAD) (abdominal circumference [AC]/π) and biparietal diameter (BPD) (TAD-BPD) has been reported as a risk factor for shoulder dystocia in different countries; however, it remains unclear if this relationship is relevant in Japan. This study aimed to clarify the association between TAD-BPD and shoulder dystocia after adjusting for potential confounding factors in a Japanese cohort. We retrospectively examined 1,866 Japanese women who delivered vaginally between 37+0 and 41+6 weeks of gestation at the University of Yamanashi Hospital between June 2012 and November 2018. The cutoff value of TAD-BPD associated with shoulder dystocia and the association between TAD-BPD and shoulder dystocia were evaluated. The mean maternal age was 32.5±5.3 years; the patients included 1,053 nulliparous women (57.5%), 915 male infants (49.0%), 154 women with gestational diabetes mellitus (GDM) (8.3%), and 5 infants with macrosomia (0.3%). The mean TAD-BPD was 9.03±4.7 mm. The overall incidence of shoulder dystocia was 2.4% (44/1866). The cutoff value to predict shoulder dystocia was 12.0 mm (sensitivity, 61.4%; specificity, 73.8%; likelihood ratio, 2.34; positive predictive value, 5.4%; negative predictive value, 98.8%). We then used a multivariable logistic regression analysis to examine the association between TAD-BPD and shoulder dystocia while controlling for the potential confounding factors. In multivariate analyses, TAD-BPD ≥12.0 mm (adjusted odds ratio [OR], 4.39; 95% confidence interval [CI], 2.35–8.18) and GDM (adjusted OR, 3.59; 95% CI, 1.71–7.52) were associated with shoulder dystocia. Although TAD-BPD appears to be a relevant risk factor for shoulder dystocia, sonographic fetal anthropometric measures do not appear to be useful in screening for shoulder dystocia due to a low positive predictive value.
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spelling pubmed-78804862021-02-19 Risk assessment of shoulder dystocia via the difference between transverse abdominal and biparietal diameters: A retrospective observational cohort study Shinohara, Satoshi Okuda, Yasuhiko Hirata, Shuji PLoS One Research Article Shoulder dystocia is defined as vaginal cephalic delivery that requires additional obstetric maneuvers to deliver the fetus after the head has been delivered and gentle traction has failed. A bigger difference between the transverse abdominal diameter (TAD) (abdominal circumference [AC]/π) and biparietal diameter (BPD) (TAD-BPD) has been reported as a risk factor for shoulder dystocia in different countries; however, it remains unclear if this relationship is relevant in Japan. This study aimed to clarify the association between TAD-BPD and shoulder dystocia after adjusting for potential confounding factors in a Japanese cohort. We retrospectively examined 1,866 Japanese women who delivered vaginally between 37+0 and 41+6 weeks of gestation at the University of Yamanashi Hospital between June 2012 and November 2018. The cutoff value of TAD-BPD associated with shoulder dystocia and the association between TAD-BPD and shoulder dystocia were evaluated. The mean maternal age was 32.5±5.3 years; the patients included 1,053 nulliparous women (57.5%), 915 male infants (49.0%), 154 women with gestational diabetes mellitus (GDM) (8.3%), and 5 infants with macrosomia (0.3%). The mean TAD-BPD was 9.03±4.7 mm. The overall incidence of shoulder dystocia was 2.4% (44/1866). The cutoff value to predict shoulder dystocia was 12.0 mm (sensitivity, 61.4%; specificity, 73.8%; likelihood ratio, 2.34; positive predictive value, 5.4%; negative predictive value, 98.8%). We then used a multivariable logistic regression analysis to examine the association between TAD-BPD and shoulder dystocia while controlling for the potential confounding factors. In multivariate analyses, TAD-BPD ≥12.0 mm (adjusted odds ratio [OR], 4.39; 95% confidence interval [CI], 2.35–8.18) and GDM (adjusted OR, 3.59; 95% CI, 1.71–7.52) were associated with shoulder dystocia. Although TAD-BPD appears to be a relevant risk factor for shoulder dystocia, sonographic fetal anthropometric measures do not appear to be useful in screening for shoulder dystocia due to a low positive predictive value. Public Library of Science 2021-02-12 /pmc/articles/PMC7880486/ /pubmed/33577577 http://dx.doi.org/10.1371/journal.pone.0247077 Text en © 2021 Shinohara et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Shinohara, Satoshi
Okuda, Yasuhiko
Hirata, Shuji
Risk assessment of shoulder dystocia via the difference between transverse abdominal and biparietal diameters: A retrospective observational cohort study
title Risk assessment of shoulder dystocia via the difference between transverse abdominal and biparietal diameters: A retrospective observational cohort study
title_full Risk assessment of shoulder dystocia via the difference between transverse abdominal and biparietal diameters: A retrospective observational cohort study
title_fullStr Risk assessment of shoulder dystocia via the difference between transverse abdominal and biparietal diameters: A retrospective observational cohort study
title_full_unstemmed Risk assessment of shoulder dystocia via the difference between transverse abdominal and biparietal diameters: A retrospective observational cohort study
title_short Risk assessment of shoulder dystocia via the difference between transverse abdominal and biparietal diameters: A retrospective observational cohort study
title_sort risk assessment of shoulder dystocia via the difference between transverse abdominal and biparietal diameters: a retrospective observational cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880486/
https://www.ncbi.nlm.nih.gov/pubmed/33577577
http://dx.doi.org/10.1371/journal.pone.0247077
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