Can shoulder dystocia be reliably predicted by estimating fetal weight?
The problems with attempting to estimate which fetuses will be macrosomic and using this information as a tool for predicting shoulder dystocia are twofold: In the first place, it is the general conclusion of most obstetrical experts who have studied this issue that predicting macrosomia is unreliable. If macrosomia cannot be reliably determined, it is hard to try to use it to predict shoulder dystocia. Secondly, only a very small percentage of babies, even of those who have macrosomia, go on to develop shoulder dystocia. This presents a significant obstacle to the use of estimates of fetal weight as a tool for deciding when to change clinical management in hopes of preventing shoulder dystocia deliveries. These difficulties are highlighted in the data presented below: Resnick (1980) found that shoulder dystocia occurred in only 1.7% of 1409 infants born at Johns Hopkins Hospital weighing more than 4000 g. Acker (1986) pointed out that although the relative frequency of shoulder dystoc
