OBJECTIVE: Diabetes is predisposed to shoulder dystocia (SHD). Despite the magnitude of the problem, a dearth of information is available. Therefore, we sought to characterize SHD in different types of diabetes. METHODS: In a 7 yr period, 289 pre-existing diabetics (PEDM) and 3650 gestational diabetics (GDM) were vaginally delivered and included in the study. Data was prospectively collected on all subjects. Diabetic management followed established, previously published protocol addressing multiple blood glucose testing and stringent glycémie control. Multiple neonatal and maternal outcome variables included: maternal and neonatal birth trauma, neonatal fractures, and palsy. Patients were stratified by diabetic type (PEDM and GDM), class (Al, A2, B-C, D-RF), and birth weight. RESULTS: The overall incidence of SHD for GDM was 1.5% and 8.1% for PEDM. The table below displays the rate of SHD within each birth percentile and weight category. GDM PEDM Wt. Birth % wt. birth % wt. birth % low-3499 low 10 0.3% 0.4% 2.2% - 3500-3999 25-50 1.7% 0.2% 13.3% 2.0% 4000-4249 75 6.4% 1.5% 25.0% 9.8% 4250-4499 90 9.9% 3.7% 40.0% 19.0% 4500-high >95 20.3% 16.6% 55.6% 57.0% 1) The rate of macrosomia and SHD within the macrosomic infants was GDM, 7.7% and 58% and PEDM, 10.8% and 40%, respectively. 2) In GDM the rate of trauma (fractures) was 13.5% SHD and 0.8% in non-SHD patients. 3) For PEDM, trauma 26% and .05% fractures in non-SHD subjects. 4) Brachial palsy was identified in the SHD GDMs at a rate of 7.7% and only 0.2% in non-SHD GDMs. 5) PEDMs brachial palsy was 6.7% in SHD and no cases in non-shoulder. 6) Additional outcome variables (eg. ICU admission, cord pH at deliver)', and Apgar score were significantly greater in SHD diabetic groups. CONCLUSION: SHD is a severe complication in both GDMs and PEDMs. Identification of the fetus with excess weight may decrease the rate of this complication and, therefore, morbidity for the neonate.
|Original language||English (US)|
|Journal||Acta Diabetologica Latina|
|Issue number||1 PART II|
|State||Published - Dec 1 1997|
ASJC Scopus subject areas
- Internal Medicine
- Endocrinology, Diabetes and Metabolism