{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T05:28:25Z","timestamp":1730870905289,"version":"3.28.0"},"reference-count":39,"publisher":"Georg Thieme Verlag KG","issue":"07","funder":[{"name":"Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health including ARRA funding.","award":["HHSN275200800013C;HHSN275200800002I;HHSN27500006;H"],"award-info":[{"award-number":["HHSN275200800013C;HHSN275200800002I;HHSN27500006;H"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:p>\n            Objective\u2003This study aimed to evaluate fetal biometrics as predictors of shoulder dystocia (SD) in a low-risk obstetrical population.<\/jats:p><jats:p>\n            Study Design\u2003Participants were enrolled as part of a U.S.-based prospective cohort study of fetal growth in low-risk singleton gestations (n\u2009=\u20092,802). Eligible women had liveborn singletons \u22652,500\u2009g delivered vaginally. Sociodemographic, anthropometric, and pregnancy outcome data were abstracted by research staff. The diagnosis of SD was based on the recorded clinical impression of the delivering physician. Simple logistic regression models were used to examine associations between fetal biometrics and SD. Fetal biometric cut points, selected by Youden's J and clinical determination, were identified to optimize predictive capability. A final model for SD prediction was constructed using backward selection. Our dataset was randomly divided into training (60%) and test (40%) datasets for model building and internal validation.<\/jats:p><jats:p>\n            Results\u2003A total of 1,691 women (98.7%) had an uncomplicated vaginal delivery, while 23 (1.3%) experienced SD. There were no differences in sociodemographic or maternal anthropometrics between groups. Epidural anesthesia use was significantly more common (100 vs. 82.4%; p\u2009=\u20090.03) among women who experienced SD compared with those who did not. Amniotic fluid maximal vertical pocket was also significantly greater among SD cases (5.8\u2009\u00b1\u20091.7 vs. 5.1\u2009\u00b1\u20091.5\u2009cm; odds ratio\u2009=\u20091.32 [95% confidence interval: 1.03,1.69]). Several fetal biometric measures were significantly associated with SD when dichotomized based on clinically selected cut-off points. A final prediction model was internally valid with an area under the curve of 0.90 (95% confidence interval: 0.81, 0.99). At a model probability of 1%, sensitivity (71.4%), specificity (77.5%), positive (3.5%), and negative predictive values (99.6%) did not indicate the ability of the model to predict SD in a clinically meaningful way.<\/jats:p><jats:p>\n            Conclusion\u2003Other than epidural anesthesia use, neither sociodemographic nor maternal anthropometrics were significantly associated with SD in this low-risk population. Both individually and in combination, fetal biometrics had limited ability to predict SD and lack clinical usefulness.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/a-1787-6991","type":"journal-article","created":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T23:59:55Z","timestamp":1646351995000},"page":"891-901","source":"Crossref","is-referenced-by-count":0,"title":["Fetal Growth Biometry as Predictors of Shoulder Dystocia in a Low-Risk Obstetrical Population"],"prefix":"10.1055","volume":"41","clinical-trial-number":[{"clinical-trial-number":"nct00912132","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Roger B.","family":"Newman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danielle R.","family":"Stevens","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly J.","family":"Hunt","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William A.","family":"Grobman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Owen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Sciscione","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Christiana Health Care Center, Wilmington, Delaware"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronald J.","family":"Wapner","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Skupski","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, New York Presbyterian Queens, Flushing, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward K.","family":"Chien","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Case Western Reserve University, Metro Health Medical Center, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah A.","family":"Wing","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of California, Irvine; Orange, California"},{"name":"Department of Obstetrics and Gynecology, Fountain Valley Regional Hospital and Medical Center, Fountain Valley, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela C.","family":"Ranzini","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Case Western Reserve University, Metro Health Medical Center, Cleveland, Ohio"},{"name":"Department of Obstetrics and Gynecology, Saint Peter's University Hospital, New Brunswick, New Jersey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuel","family":"Porto","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of California, Irvine; Orange, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine L.","family":"Grantz","sequence":"additional","affiliation":[{"name":"Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,6,30]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1097\/00003081-200206000-00006","article-title":"Shoulder dystocia: an evidence-based evaluation of the obstetric nightmare","volume":"45","author":"R B Gherman","year":"2002","journal-title":"Clin Obstet Gynecol"},{"issue":"06","key":"ref3","doi-asserted-by":"crossref","first-page":"1408","DOI":"10.1016\/0002-9378(87)90008-1","article-title":"Shoulder dystocia: a fetal-physician risk","volume":"156","author":"T L Gross","year":"1987","journal-title":"Am J Obstet Gynecol"},{"issue":"06","key":"ref4","first-page":"762","article-title":"Risk factors for shoulder dystocia","volume":"66","author":"D B Acker","year":"1985","journal-title":"Obstet Gynecol"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1016\/S0002-9378(98)70382-5","article-title":"Shoulder dystocia and associated risk factors with macrosomic infants born in California","volume":"179","author":"T S Nesbitt","year":"1998","journal-title":"Am J Obstet Gynecol"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/j.ajog.2004.12.020","article-title":"Suspicion and treatment of the macrosomic fetus: a review","volume":"193","author":"S P Chauhan","year":"2005","journal-title":"Am J Obstet Gynecol"},{"issue":"05","key":"ref7","doi-asserted-by":"crossref","first-page":"517.e1","DOI":"10.1016\/j.ajog.2007.12.005","article-title":"How big is too big? 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