Page 31 - OB Risks - Delivering the Goods (Part Two)

SVMIC Obstetrics Risks: Delivering the Goods

• Post-term gestation
• Maternal diabetes

• Previous history of a macrosomic birth

• Maternal obesity

• Previous history of shoulder dystocia
50

Ultrasound may provide an estimate of fetal weight, but
ultrasonography is not always an accurate predictor of

macrosomia. Even when the baby is heavier than normal,
51 52
shoulder dystocia may not occur. Again, the burden falls on

effective education and communication to ensure the patient
and/or the patient’s family has the information needed to

participate in decision-making processes. This education should
include possible risk factors due to the patient’s obstetrical

history, whether the patient has diabetes, and current diagnostic
or physical findings. These discussions should begin early in
53
pregnancy and continue throughout the pregnancy. The patient
should be aware of delivery techniques to address shoulder

dystocia including the purpose of the maneuvers, possible
alternative methods of treatment, the risks involved, and the

possibility of complications. This discussion should be repeated
and well-documented as the pregnancy continues and the risk

factors persist.

50 Id.
51 Macrosomia ACOG Practice Bulletin, Number 216
52 https://journals.lww.com/greenjournal/fulltext/2020/01000/macrosomia__acog_practice_
bulletin,_number_216.50.aspx
53 https://www.obgproject.com/2019/08/02/shoulder-dystocia-diagnosis-evaluation-and-
management/

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