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Sonographic Fetal Asymmetry Predicts Shoulder Dystocia

Division of Maternal-Fetal Medicine; Columbia University Medical Center, New York, New York USA.

Address correspondence to Russell S. Miller, MD, Division of Maternal-Fetal Medicine, Columbia University Medical Center, 622 W 168th St, PH 16-66, New York, NY 10032 USA. E-mail: rsm20{at}columbia.edu

Objective. The purpose of this study was to evaluate the performance of a sonographic measurement of fetal asymmetry, abdominal diameter minus biparietal diameter (AD – BPD), in the prediction of shoulder dystocia (SD) in a patient population that was unselected for diabetes mellitus (DM) status. Methods. Patients who underwent sonographic estimations of fetal biometric measurements within 14 days of vaginally delivered live-born singleton neonates weighing 3400 g or greater at a tertiary care institution were included in this retrospective cohort. The mean AD – BPD was retrospectively compared in deliveries complicated by SD with those without SD by the Student t test. A receiver operating characteristic curve was generated to determine the optimal cutoff for SD prediction. Test performance characteristics of AD – BPD were determined. Results. Of 5204 deliveries, 332 met inclusion criteria. Shoulder dystocia complicated 23 deliveries (6.9%). The mean AD – BPD was significantly higher in the dystocia group (2.39 versus 1.97; P = .0002). With an AD – BPD of 2.6 cm or greater, the risk rates of SD were 25% for unselected patients and 38.5% with DM. Conclusions. An AD – BPD of 2.6 cm or greater identifies a subset of patients with and without DM at risk for SD.

Key Words: fetal biometry • shoulder dystocia • sonography

Abbreviations: AC, abdominal circumference • ACOG, American College of Obstetricians and Gynecologists • AD, abdominal diameter • BPD, biparietal diameter • CI, confidence interval • DM, diabetes mellitus • EFW, estimated fetal weight • LR, likelihood ratio • NPV, negative predictive value • OR, odds ratio • PPV, positive predictive value • SD, shoulder dystocia

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				R. D. Jelsema and R. S. Miller Sonographic Fetal Asymmetry Predicts Shoulder Dystocia * Reply J. Ultrasound Med., April 1, 2008; 27(4): 682 - 683. [Full Text] [PDF]