A Survey of Central Association Members About the Definition, Management, and Complications of Shoulder Dystocia

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Abstract
OBJECTIVES: To determine practice patterns for shoulder dystocia and concepts dealing with brachial plexus palsy. METHODS: An Internet-based 25-question survey was electronically disseminated to all current members of the Central Association of Obstetricians and Gynecologists. For those individuals who did not respond, an additional opportunity to complete the assessment was provided during the 2009 annual meeting. RESULTS: Of 429 Central Association of Obstetricians and Gynecologists members, 268 (62%) responded, with 192 (78%) filling out the survey online. Nearly 90% of those queried believed that shoulder dystocia was unpredictable and unpreventable. Thirty-seven percent felt that an elective cesarean delivery should be offered for an estimated fetal weight of 4,500 g among nondiabetics. Just 40% would have allowed a trial of labor with a documented history of shoulder dystocia. Slightly more than half answered that they never used either lateral or excessive traction and obstetrician–gynecologists were more likely than maternal–fetal medicine specialists to conclude that traction applied by the clinician doing the delivery was the cause of shoulder dystocia-related brachial plexus palsy (36% compared with 12%, P=.005). Maternal–fetal medicine specialists were more likely to believe that 40–50% of brachial plexus palsies occur without concomitant shoulder dystocia (21% compared with 9%, P=.015). CONCLUSION: Differences in practice patterns exist among with regard to management recommendations of the American College of Obstetricians and Gynecologists' Practice Bulletin on shoulder dystocia. LEVEL OF EVIDENCE: III

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