A 6-YEAR RETROSPECTIVE ANALYSIS OF SHOULDER DYSTOCIA AND DELIVERY OF THE SHOULDERS

Objective: to investigate the diagnosis, incidence and management of s houlder dystocia, Design: retrospective review of all the deliveries b etween 1988 and 1993 which were coded on the computer data base as 'mo derate difficulty with the shoulders' or 'shoulder dystocia'. Setting: a teaching hospital in the south of England. Participants: the study population consisted of 15 658 women who had cephalic vaginal deliveri es of babies weighing > 2.5 kg, The sample consisted of the 257 women reported to have moderate difficulty with the shoulders or shoulder dy stocia at delivery, Findings: there was a significant fall in the repo rted incidence of shoulder dystocia during the period under investigat ion. Eighty-six (1.1%) of the deliveries between 1988 and 1990 were re ported to have been complicated by shoulder dystocia, In 1991 a second option was introduced to allow both shoulder dystocia or moderate dif ficulties with the shoulders to be coded after delivery. Following thi s change in categorisation, the incidence of shoulder dystocia was red uced to 30 (0.6%) reported cases in 1992-1993, Over the same period th e reported incidence of moderate difficulty rose significantly from 29 (1.1%) in 1992 to 60 (2.4%) in 1993 (P < 0.001). Disparity was noted between the experience of practitioners and contemporary definitions o f shoulder dystocia and this was highlighted by the number of reported cases of moderate difficulty. In this study practitioners used the te rm shoulder dystocia in a general sense to describe a range of difficu lties encountered with the delivery of the shoulders and they identifi ed many varied manifestations. In comparison, contemporary literature describes shoulder dystocia as a discrete entity. Key conclusions: sho ulder dystocia is a complex clinical scenario and perceptions of the i ncidence may be influenced by alterations in the delivery technique an d changes in the diagnosis and documentation. Implications for practic e: the application of traction may interfere with the normal mechanism s of labour and the spontaneous birth of the shoulders, whilst increas ing the risk of trauma to the baby. It may be unnecessary to use such interventions routinely in the care of normal labouring women.