A new approach to predicting shoulder dystocia: fetal clavicle measurement

Background/aim: This study aimed to evaluate the relationship between second- and third-trimester clavicle lengths and birth weight and shoulder dystocia. Materials and methods: This prospective observational study included 181 patients who presented to the Private Etlik Lokman Hekim Hospital for routine pregnancy visits between March 2019 and March 2020. In addition to routine pregnancy examinations, the patients also underwent ultrasonography twice at weeks 20–23 and 33–36 to determine the length of the fetal clavicle. The patients were evaluated for shoulder dystocia in the second stage of labor. The birth weight of the neonates was recorded. The primary objective of this study was to establish the relationship between third-trimester clavicle length and shoulder dystocia. Results: Fetal clavicle length increases in the second trimester with the advancing gestational week but does not significantly change in the third trimester. We did not observe any significant difference for second trimester clavicle length between the type of delivery, birth weight, or shoulder dystocia. Moreover, we did not observe any significant difference for third trimester clavicle length between types of delivery. However, we found a significant relationship between third trimester clavicle length and birth weight and shoulder dystocia. The median third-trimester clavicle length was 39.5 mm (range: 30.7–43.9) in neonates who did not develop shoulder dystocia and 42.5 mm (range: 41.4–43.1) in the 3 neonates who developed shoulder dystocia. The third-trimester clavicle length cut-off for shoulder dystocia was calculated as 41.35 mm (sensitivity: 100.00%, specificity: 83.82%, accuracy: 84.5%). The third-trimester clavicle length cut-off for macrosomia (defined as birth weight of ≥4100 g) was 40.75 mm (sensitivity: 87.50%, specificity: 77.56%, accuracy: 78.05%). Conclusion: Third-trimester fetal clavicle length, an important component of biacromial diameter, as measured by ultrasonography, is a practical and significant method for predicting macrosomia and shoulder dystocia.Key words: Clavicle/growth and development, fetal macrosomia, shoulder dystocia, parturition

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1. Barros JG, Reis I, Pereira I, Clode N, Graça LM. Estimation of fetal weight during labor: still a challenge. Revista Brasileira de Ginecologia e Obstetrícia 2016; 38(1): 4-8. doi: 10.1055/s0035-1570110
2. Gümüş İ, Karakurt F, Kargılı A, Turhan N, Uyar M . Association between prepregnancy body mass index, gestational weight gain, and perinatal outcomes. Turkish Journal of Medical Sciences 2010; 40(3): 365-370. doi: 10.3906/sag-0808-35
3. Najafian M, Cheraghi M. Occurrence of fetal macrosomia rate and its maternal and neonatal complications: a 5-year cohort study. International Scholar Research Notes 2012; 2012: 353791. doi: 10.5402/2012/353791
4. Workalemahu T, Grantz KL, Grewal J, Zhang C, Louis GMB et al. Genetic and environmental influences on fetal growth vary during sensitive periods in pregnancy. Scientific Reports 2018; 8(1): 1-8. doi: 10.1038/s41598-018-25706-z
5. Champion ML, Harper LM. Gestational weight gain: update on outcomes and interventions. Current Diabetes Reports 2020; 20(3): 11. doi: 10.1007/s11892-020-1296-1
6. Lei F, Zhang L, Shen Y, Zhao Y, Kang Y et al. Association between parity and macrosomia in Shaanxi Province of Northwest China. Italian Journal of Pediatrics 2020; 46(1): 24. doi: 10.1186/s13052-020-0784-x
7. Muhcu M, Özdamar Ö, Gün İ, Özden O, Müngen E et al. The impact of the fetal gender on ultrasonographic fetal biometric parameters. Zeynep Kamil Tıp Bülteni 2014; 45(2): 55-60.
8. Secher NJ, Djursing H, Hansen PK, Lenstrup C, Sindberg Eriksen P et al. Estimation of fetal weight in the third trimester by ultrasound. European Journal of Obstetrics & Gynecology and Reproductive Biology 1987; 24(1): 1-11. doi: 10.1016/0028- 2243(87)90031-1
9. Agudelo-Espitia V, Parra-Sosa BE, Restrepo-Mesa SL. Factors associated with fetal macrosomia. Revista de Saude Publica 2019; 53: 100. doi: 10.11606/s1518-8787.2019053001269
10. Weissmann-Brenner A, Simchen MJ, Zilberberg E, Kalter A, Weisz B et al. Maternal and neonatal outcomes of macrosomic pregnancies. Medical Science Monitor 2012; 18(9): 77-81. doi: 10.12659/msm.883340
11. Pahlitzsch TMJ, Hanne L, Henrich W, Weichert A. Influence of foetal macrosomia on the neonatal and maternal birth outcome. Geburtshilfe und Frauenheilkunde 2019; 79(11): 1191-1198. doi: 10.1055/a-0880-618
12. Salihu HM, Dongarwar D, King LM, Yusuf KK, Ibrahimi S et al. Phenotypes of fetal macrosomia and risk of stillbirth among term deliveries over the previous four decades. Birth 2020; 47(2): 202-210. doi: 10.1111/birt.12479
13. Vitner D, Bleicher I, Kadour-Peero E, Lipworth H, Sagi S et al. Does prenatal identification of fetal macrosomia change management and outcome? Archives of Gynecology and Obstetrics 2019; 299(3): 635-644. doi: 10.1007/s00404-018- 5003-2
14. Wu M, Shao G, Zhang F, Ruan Z, Xu P et al. Estimation of fetal weight by ultrasonic examination. International Journal of Clinical and Experimental Medicine 2015; 8(1): 540-545.
15. Hadlock FP, Harrist RB, Martinez-Poyer J. In utero analysis of fetal growth: a sonographic weight standard. Radiology 1991; 181(1): 129-133. doi: 10.1148/radiology.181.1.1887021
16. Hoopmann M, Abele H, Wagner N, Wallwiener D, Kagan KO. Performance of 36 different weight estimation formulae in fetuses with macrosomia. Fetal Diagnosis and Therapy 2010; 27(4): 204-213. doi: 10.1159/000299475
17. Mazzone E, Dall’Asta A, Kiener AJO, Carpano MG, Suprani A et al. Prediction of fetal macrosomia using two-dimensional and three-dimensional ultrasound. European Journal of Obstetrics & Gynecology and Reproductive Biology 2019; 243: 26-31. doi: 10.1016/j.ejogrb.2019.10.003
18. Dall’Asta A, Rizzo G, Kiener A, Volpe N, Di Pasquo E et al. Identification of large-for-gestational age fetuses using antenatal customized fetal growth charts: Can we improve the prediction of abnormal labor course? European Journal of Obstetrics & Gynecology and Reproductive Biology 2020; 248: 81-88. doi: 10.1016/j.ejogrb.2020.03.024
19. Galbiatti JA, Cardoso FL, Galbiatti MGP. Obstetric paralysis: who is to blame? A systematic literature review. Revista Brasileira de Ortopedia 2020; 55(2): 139-146. doi: 10.1055/s0039-1698800
20. Spong CY, Beall M, Rodrigues D, Ross MG. An objective definition of shoulder dystocia: prolonged head-to-body delivery intervals and/or the use of ancillary obstetric maneuvers. Obstetrics and Gynaecology 1995; 86(3): 433-436. doi: 10.1016/0029-7844(95)00188
21. Menticoglou S. Shoulder dystocia: incidence, mechanisms, and management strategies. International Journal of Women’s Health 2018; 10: 723-732. doi: 10.2147/IJWH.S175088
22. Gherman RB. Shoulder dystocia: prevention and management. Obstetrics and Gynecology Clinics of North America 2005; 32(2): 297-305. doi: 10.1016/j.ogc.2004.12.006
23. Madendag Y, Aksoy U, Col Madendag I, Aksoy H. Fetal frontabdominal wall thickness in the second trimester as a predictor of abnormal fetal growth. Journal of Maternal-Fetal and Neonatal Medicine 2020; 1-7. doi: 10.1080/14767058.2020.1743666
24. Yarkoni S, Schmidt W, Jeanty P, Reece EA, Hobbins JC. Clavicular measurement: a new biometric parameter for fetal evaluation. Journal of Ultrasound in Medicine 1985; 4(9): 467- 470. doi: 10.7863/jum.1985.4.9.467
25. Sherer DM, Sokolovski M, Dalloul M, Khoury-Collado F, Osho JA et al. Fetal clavicle length throughout gestation: a nomogram. Ultrasound in Obstetrics and Gynecology 2006; 27(3): 306-310. doi: 10.1002/uog.2706.
26. Gherman RB, Goodwin TM, Souter I, Neumann K, Ouzounian JG et al. The McRoberts’ maneuver for the alleviation of shoulder dystocia: how successful is it? American Journal of Obstetrics and Gynecology 1997; 176(3): 656-661. doi: 10.1016/s0002-9378(97)70565-9
27. Gurewitsch ED, Kim EJ, Yang JH, Outland KE, McDonald MK et al. Comparing McRoberts’ and Rubin’s maneuvers for initial management of shoulder dystocia: an objective evaluation. American Journal of Obstetrics and Gynecology 2005; 192(1): 153-160. doi: 10.1016/j.ajog.2004.05.055
28. Keskin U, Ercan CM, Güngör S, Karaşahin KE, Ergün A et al. The effects of gestational diabetes mellitus screening and diagnostic tests on fetal macrosomia. Perinatal Journal 2013; 21(3): 133-137. doi: 10.2399/prn.13.0213007
29. Modanlou HD, Komatsu G, Dorchester W, Freeman RK, Bosu SK. Large-for-gestational-age neonates: anthropometric reasons for shoulder dystocia. Obstetrics and Gynaecology 1982; 60(4): 417-423.
30. Winn HN, Holcomb W, Shumway JB, al-Malt A, Amon E et al. The neonatal bisacromial diameter: a prenatal sonographic evaluation. Journal of Perinatal Medicine 1997; 25(6): 484-487. doi: 10.1515/jpme.1997.25.6.484
31. Youssef AEA, Amin AF, Khalaf M, Khalaf MS, Ali MK et al. Fetal biacromial diameter as a new ultrasound measure for prediction of macrosomia in term pregnancy: a prospective observational study. Journal of Maternal-Fetal and Neonatal Medicine 2019; 32(16): 2674-2679. doi: 10.1080/14767058.2018.1445714
32. Crönlein M, Postl L, Beirer M, Pforringer D, Lang J et al. Analysis of the bony geometry of the acromio-clavicular joint. European Journal of Medical Research 2018; 23(1): 50. doi: 10.1186/s40001-018-0348-3
33. Maruotti GM, Saccone G, Martinelli P. Third trimester ultrasound soft-tissue measurements accurately predicts macrosomia. Journal of Maternal-Fetal and Neonatal Medicine 2017; 30(8): 972-976. doi: 10.1080/14767058.2016.1193144
34. Duryea EL, Casey BM, McIntire DD, Twickler DM. The FL/AC ratio for prediction of shoulder dystocia in women with gestational diabetes. Journal of MaternalFetal and Neonatal Medicine 2017; 30(19): 2378-2381. doi: 10.1080/14767058.2016.1249842