From the Editor
Transfer to the hospital for women planning a home birth: A high-risk obstetrics problem
Do you have a written clinical guideline for pregnant women planning a home birth who are transferred to your hospital?
Recommendations for practice
At the close of its second chapter (“Risk and predictive factors”), the ACOG report offers the same official recommendations that appear in its current practice bulletin on shoulder dystocia. It notes that there are three clinical situations in which it may be prudent to alter usual obstetric management, with an aim of reducing the risk of shoulder dystocia and NBPP:
- when fetal macrosomia is suspected, with fetal weight estimated to exceed 5,000 g in a woman without diabetes or 4,500 g in a woman with diabetes
- when the mother has a history of recognized shoulder dystocia, especially when neonatal injury was severe
- when midpelvic operative vaginal delivery is contemplated with a fetus estimated to weigh more than 4,000 g.
It is interesting to note that these recommendations are made, according to the report, “notwithstanding the unreliability of specific risk factors to predict NBPP or clinically apparent shoulder dystocia in a specific case.” The report further adds:
Even in these circumstances, the occurrence of NBPP is relatively low, and with proper informed consent, numerous clinical situations exist in which these risk factors alone should not dictate a particular course of management.
More to come
For ACOG’s conclusions on the pathophysiology and causation of NBPP, with a view toward formulating specific protective interventions, see Part 2 of this article, which will appear in the October 2014 issue of OBG Management.
Share your thoughts on this article! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.
