Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Aug;118(2 Pt 1):318-322.
doi: 10.1097/AOG.0b013e31822467e9.

Relationship between head-to-body delivery interval in shoulder dystocia and neonatal depression

Henry Lerner  1 , Katherine Durlacher, Samuel Smith, Emily Hamilton
Affiliations

Relationship between head-to-body delivery interval in shoulder dystocia and neonatal depression

Henry Lerner et al. Obstet Gynecol. 2011 Aug.

Erratum in

  • Obstet Gynecol. 2011 Nov;118(5):1184

Abstract

Objective: To evaluate the relationship between the head-to-body delivery interval in shoulder dystocia, persistent brachial plexus injury, and neonatal depression.

Methods: We compared the head-to-body delivery intervals in 127 cases of uncomplicated shoulder dystocia-identified using medical record coding and verified by chart review in a university--affiliated community hospital--with a series of 55 medical-legal cases of shoulder dystocia with persistent brachial plexus injury, 14 of which included neonatal depression. Neonatal depression was defined as the presence of any of the following: fetal demise, cardiopulmonary resuscitation, intubation, umbilical artery pH lower than 7.00, or 5-minute Apgar score of 5 or lower.

Results: In the uncomplicated shoulder dystocia group, the median head-to-body delivery interval was 1.0 minute (interquartile range 0.5-1.0). The median for neonates with persistent brachial plexus injury and no depression was 2.0 minutes (interquartile range 1.0-4.0). For those with both persistent brachial plexus injury and neonatal depression, the median was significantly longer at 5.3 minutes (interquartile range 3.9-13.3), P<.001.

Conclusion: Neonates born with persistent brachial plexus injury and neonatal depression after shoulder dystocia had longer head-to-body delivery intervals than those with uncomplicated shoulder dystocia or shoulder dystocia with persistent brachial plexus injury without depression. By 4 minutes, all of the neonates with uncomplicated shoulder dystocia were born. Conversely, the majority of neonates with depression-57%-had head-to-body delivery intervals greater than 4 minutes. Such information offers guidance to clinicians caught between the admonition to apply only gentle force when utilizing maneuvers to accomplish a shoulder dystocia delivery and the countervailing need to achieve delivery within a critical time frame to prevent hypoxic injury.

Level of evidence: III.

PubMed Disclaimer

References

    1. Stallings SP, Edwards RK, Johnson JWC. Correlation of head-to-body delivery intervals in shoulder dystocia and umbilical artery acidosis. Am J Obstet Gynecol 2001;185:268–74.
    1. Heazell AE, Judge JK, Bhatti NR. A retrospective study to determine if umbilical cord pH correlates with duration of delay between delivery of the head and body in shoulder dystocia. J Obstet Gynecol 2004;24:776–7.
    1. Allen RH, Rosenbaum TC, Ghidini A, Poggi SH, Spong CY. Correlating head-to- body delivery intervals with neonatal depression in vaginal births that result in permanent brachial plexus injury. Am J Obstet Gynecol 2002;187:839–42.
    1. Leung TY, Stuart O, Sahota DS, Suen SS, Lau TK, Lao TT. Head-to-body delivery interval and risk of fetal acidosis and hypoxic ischaemic encephalopathy in shoulder dystocia: a retrospective review. BJOG 2011;118:474–9.
    1. Hope P, Breslin S, Lamont L, Lucas A, Martin D, Moore I, et al. Fatal shoulder dystocia: a review of 56 cases reported to the Confidential Enquiry into Stillbirths and Deaths in Infancy. Br J Obstet Gynaecol 1998;105:1256–61.

Publication types