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- W1963584675 abstract "Shoulder dystocia (SD) remains a major cause of maternal and neonatal morbidity whose accurate prediction remains elusive. We sought to determine if accurate prediction of SD could be derived through multivariable modeling. Using the Consortium on Safe Labor database(derived from electronic medical records of 12 US medical centers), we identified women with a singleton vertex pregnancy who delivered vaginally >34 weeks. All women who incurred a SD during the course of their delivery had their charts retrospectively abstracted. Neonatal injury was defined as brachial plexus injury, fracture of the clavicle or humerus, hypoxic ischemic encephalopathy and/or intrapartum death attributable to SD. Previously reported risk factors for SD were incorporated into two multivariable models( Model 1: SD vs. No SD; Model 2: SD with Neonatal Injury vs No SD + SD without injury) and those with the greatest predictive value were retained. A total of 143,606 women met the inclusion criteria of whom 2269(1.6%) incurred a SD. Among SD cases, 135(5.9%) had a neonatal injury. Preexisting diabetes(OR 1.67), BMI(OR 1.02/kg/m2), epidural anesthesia(OR 1.17), gestational age(OR 0.94/week), birthweight(OR1.003/gm), parity(OR 0.96/per prior birth), operative vaginal delivery(OR 1.67), and public insurance(OR 1.61) were all statistically associated with SD(Model 1). This model provided a sensitivity of 66% and a specificity of 83% with a number needed to treat (NNT) of 17.4 per case of SD(C = 0.83). Model 2(SD with Neonatal inury) was statistically associated with preexisting diabetes(OR 2.60), BMI(OR 1.08/kg/m2), birthweight(OR 1.003/gm), parity(OR 0.72/prior birth), and operative vaginal delivery(OR 2.10). This model provided a sensitivity of 70%, a specificity of 87% with a NNT of 200.5 per case of SD with neonatal injury(C=0.79). Multivariable modelling may provide more accurate identification of SD. Despite improved prediction, the number of cesarean deliveries required to prevent one case of neonatal injury (200.5) is high, likely making it medically and financially prohibitive." @default.
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- W1963584675 date "2011-01-01" @default.
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- W1963584675 title "314: Predictors of shoulder dystocia with and without neonatal injury using multivariable modeling" @default.
- W1963584675 doi "https://doi.org/10.1016/j.ajog.2010.10.332" @default.
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