Shoulder dystocia and long-term neurological morbidity of the offspring; results from a population-based study

Objective
Shoulder dystocia represents an obstetric emergency due to the short window of opportunity to relieve the obstruction prior to the onset of hypoxic brain injury. Although dire complications such as hypoxic-ischemic encephalopathy and death are infrequently encountered, the neurological prognosis of the other successfully delivered infants have not been previously assessed. In this study we sought to examine the implications of shoulder dystocia on long-term neurological outcome of the offspring.

Study Design
A population-based cohort analysis including deliveries between the years 1991 to 2014 in a tertiary referral hospital was conducted. Incidence of hospitalizations (up to age 18 years) due to various neurological conditions was compared between offspring of both groups. Kaplan-Meyer curve was used to assess cumulative hospitalization incidence. Cox proportional hazards model was used to control for baseline selected confounders.

Results
During the study period 206,731 deliveries met the inclusion criteria. Of those, 0.2% (n=343) were complicated by shoulder dystocia. In most of the investigated neurological conditions, including the risk for cerebral palsy, no significant differences were found between offspring of both groups (Table). Similarly, Kaplan-Meyer survival curve revealed comparable rates of cumulative neurological-related hospitalization in both groups (log rank p-value=0.342; Figure). Using a Cox proportional hazards model to control for gestational age, shoulder dystocia did not appear to be independently associated with total neurological hospitalization (adjusted HR = 0.73; 95% CI 0.36-1.47; p=0.381).