Predictive Factors of the Occurrence of Shoulder Dystocia in Diabetic Mothers [ID 2683495]

Résumé fourni par la source

INTRODUCTION: Maternal diabetes is associated with shoulder dystocia that places the newborn and mother at high risk of morbidity and complications. In the diabetic population, obstetricians lack definitive predictive factors that may improve the counseling, preparation, and management before delivery. This study evaluates prenatal maternal and fetal factors that would predict shoulder dystocia prior to delivery in diabetic mothers. METHODS: This is a cross-sectional case–control study of 63 diabetic mothers with shoulder dystocia and 200 diabetic mothers without shoulder dystocia delivered at a single medical center between January 2013 and December 2021. Maternal and neonatal characteristics were obtained. Among the studied maternal characteristics were body mass index, height, weight, ethnicity, age, gestational age, medical comorbidities (including preeclampsia and essential hypertension), hemoglobin A1C, insulin administration, labor type, parity, and health insurance type (public versus private). Neonatal characteristics included weight, height, length, and head circumference. Statistical analysis was performed using univariate and multivariate logistic regression. A value of P<.05 was considered statistically significant. RESULTS: There was no statistical difference among most of the maternal and neonatal characteristics between the two groups using univariate and multivariate analysis. We did find a statistically significant association between the incidence of shoulder dystocia and lower maternal gravidity (P=.016), larger neonatal weight (P=.00001), smaller neonatal head circumference (P=.025), smaller head circumference/weight ratio (P=.00001), and smaller head circumference/length ratio (P=.00001). CONCLUSION: Our preliminary results indicate that most available maternal and neonatal characteristics were not able to predict perinatal injury. Our sample size and the complexity of etiologies behind neonatal injury are possible reasons behind our non-statistically significant results. Over the coming 2 months, based on the association between shoulder dystocia and neonatal weight and head circumference, we will evaluate third-trimester ultrasound head circumference/abdominal circumference ratio and the ability to predict shoulder dystocia with and without neonatal injury.

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