Head-to-body delivery interval and risk of fetal acidosis and hypoxic ischaemic encephalopathy in shoulder dystocia: a retrospective review: Head-to-body delivery interval in shoulder dystocia
Abstract
OBJECTIVE: To examine the association between head-to-body delivery interval (HBDI) and cord arterial pH and base excess (BE), and the risk of development of hypoxic ischaemic encephalopathy (HIE). DESIGN: Retrospective review. SETTING: A university hospital. POPULATION: Pregnancies complicated with shoulder dystocia during the period 1995-2009. METHODS: Cases were identified from a search of the hospital electronic delivery records. Cord arterial pH and BE, and the incidence of HIE and perinatal death, were retrieved from medical records and correlated with HBDI, birth weight, mode of delivery and presence of nonreassuring fetal heart rate pattern and maternal diabetes using univariate analysis, followed by multivariate analysis. MAIN OUTCOME MEASURES: Any association between cord pH and HBDI. RESULTS: Of the 200 cases identified, the mean (standard deviation) HBDI was 2.5 minutes (1.5 minutes). Both HBDI and the presence of nonreassuring fetal heart rate pattern were independent factors for pH, and HBDI was the only significant factor for BE. Arterial pH dropped at a rate of 0.011 per minute [95% confidence interval (95% CI), 0.017-0.004; P = 0.002] with HBDI. The mode of delivery, birth weight and maternal diabetes did not affect blood gas levels. The respective risks of severe acidosis (pH < 7) and HIE with HBDI of <5 minutes were 0.5% and 0.5% versus 5.9% and 23.5% with HBDI ≥ 5 minutes. CONCLUSIONS: Cord arterial pH drops with HBDI during shoulder dystocia, but the risk of acidosis or HIE is very low with HBDI < 5 minutes.
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The median decision-to-delivery interval in this unit was 15 min.
“As reported previously, we were able to achieve a median decision‐to‐delivery interval of 15 min.”
From Neonatal outcome of infants with umbilical cord arterial <scp>pH</scp> less than 7 (2023) · cites this paper as [7]
Quick delivery with a short bradycardia-to-delivery interval reduces the chance of severe acidosis.
“first, quick delivery with a short bradycardia‐to‐delivery interval reduces the chance of severe acidosis.”
From Neonatal outcome of infants with umbilical cord arterial <scp>pH</scp> less than 7 (2023) · cites this paper as [7]
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- Authors
- Leung, T., Stuart, O., Sahota, D., Suen, S., Lau, T., & Lao, T.
- Affiliations
- Chinese University of Hong Kong (HK)
- Royal North Shore Hospital (AU)
- Corresponding author
- Leung, TY
- ORCID
- Leung, TY
- Venue
- BJOG: An International Journal of Obstetrics & Gynaecology
- Publisher
- Wiley
- Published
- 2010-12-24
- Volume
- 118
- Issue
- 4
- Pages
- 474-479
- ISSN
- 0306-5456 (ISSN-L)
- 1470-0328
- OpenAlex
- W1503182874
- Cited by
- 132
- References
- 26
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 4 · 2023: 4 · 2022: 8 · 2021: 5 · 2020: 2 · 2019: 4 · 2018: 3 · 2017: 58 · 2016: 5 · 2015: 8 · 2014: 8 · 2013: 2 · 2012: 5
- FWCI
- 5.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and fetal brain pathology
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Keywords
- shoulder dystocia, fetal acidosis, hypoxic-ischemic encephalopathy, base excess, perinatal death, non-reassuring fetal heart rate, maternal diabetes, birth weight
- MeSH terms
- Acidosis, Adult, Dystocia, Female, Fetal Blood, Fetal Diseases, Humans, Hydrogen-Ion Concentration, Infant, Newborn, Pregnancy, Retrospective Studies, Risk Factors, Hypoxia-Ischemia, Brain, Delivery, Obstetric
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