Duewel et al reported a score for identifying a fetus at risk for shoulder dystocia prior to labor. This can help to identify a patient who may benefit from a Cesarean delivery. The authors are from St. Joseph Hospital Berlin, Humboldt University and Manchester University.
Patient selection: pregnant woman prior to delivery
Parameters:
(1) estimated fetal weight in grams
(2) abdominal circumference in cm
(3) head circumference in cm
(4) maternal diabetes mellitus (presumably preconceptual and gestational)
circumference difference in cm =
= (abdominal circumference) - (head circumference)
|
Parameter
|
Finding
|
Points
|
|
estimated fetal weight
|
< 4,250 g
|
0
|
|
|
>= 4,250 g
|
2
|
|
circumference difference
|
< 2.5 cm
|
0
|
|
|
>= 2.5 cm
|
2
|
|
diabetes mellitus
|
no
|
0
|
|
|
yes
|
1
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• A score of 4 or 5 would support the decision to delivery by Cesarean section.
• In the study 40% of the patients with shoulder dystocia had a score of 0. Only 22% had a score of 3 or higher.
|
Total Score
|
Shoulder Dystocia
|
|
0
|
0.5%
|
|
1
|
0.9%
|
|
2
|
2.1%
|
|
3
|
5.4%
|
|
4
|
10.4%
|
|
5
|
25%
|
Performance:
• The area under the ROC curve was 0.69 for the derivation and 0.71 for the validation cohorts.
