Review of shoulder dystocia at the Birmingham Women's Hospital.

A retrospective audit was performed of all deliveries between 1 January 1991 and 31 December 1995 at the Birmingham Women's Hospital, the main University Teaching Hospital in the West Midlands. This was performed by using the computer database of all hospital deliveries, at the Women's Hospital during the above-mentioned period, by entering a CCL code for shoulder dystocia. During that period of time there were 28 932 deliveries with a mean caesarean section rate of 16.7%. One hundred and fifty-four cases were identified, of which 134 case notes were available for review. The incidence of shoulder dystocia was 0.53%. Audit was performed of pre-pregnancy, antepartum and intrapartum risk factors, the severity of shoulder dystocia, the category of person delivering the baby, fetal outcome at birth and subsequent pregnancy outcome in cases of those with subsequent pregnancies. Overall, the majority of cases of shoulder dystocia were mild, and dealt with by midwives (101 cases 74%). No severe cases were encountered, however three out of eight moderate cases delivered by obstetricians had evidence of fetal trauma (one Erbs palsy and two limb fractures). Twenty women had a pregnancy after the pregnancy complicated by shoulder dystocia. Of these, 18 women delivered vaginally and there were two cases (10%) of repeat shoulder dystocia.