04 Jun

Outcomes associated with a structured prenatal counseling program for shoulder dystocia with brachial plexus injury

Mary Veronica Daly, MD, Christina Bender, MSN, Kathryn E. Townsend, JD, Emily F. Hamilton, MD

 

Objective: We examined outcomes associated with a novel program to identify patients at high risk for shoulder dystocia (SD) with BPI.

Study Design: The program included a checklist of key risk factors and a multifactorial algorithm to estimate risk of SD with BPI. We examined rates of cesarean and SD in 8,767 deliveries by clinicians enrolled in the program and in 11,958 patients of clinicians without access to program.

Results: Key risk factors were identified in 1,071/8767(12.2%) of mothers of whom 40/8767(0.46%) obtained results in the high risk category. The rate of primary cesarean rate was stable (21.2% to 20.8% P= 0.57). SD rates fell by 56.8%. (1.74% to 0.75% P=0.002). The rates of SD and cesarean birth showed no changes in the group without access to the program.

Conclusions: With the introduction of this program, overall SD rates fell by more than half with no increase in the primary cesarean rate.

Cite this article as: Daly M, Bender C, Townsend K, and Hamilton E. Outcomes associated with a structured prenatal counseling program for shoulder dystocia with brachial plexus injury. AJOG 2012 June 04.

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