Cent Eur J Nurs Midw 2026, 17(1):2398-2406

The incidence of and risk factors for shoulder dystocia in a tertiary Greek maternity hospital: a retrospective case-control study

Nikoleta Chatzipanagiotidou1, Dimitrios Papoutsis2, George Valasoulis1, Alexandros Daponte1
1 Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
2 Department of Midwifery, School of Health Sciences, University of Western Macedonia, Kozani, Greece

Aim: We aimed to determine the incidence of and risk factors for shoulder dystocia in Greek tertiary maternity settings.

Design: A retrospective case-control study.

Methods: Study of women who gave birth at the University Hospital of Larissa in Greece between 2019 and 2024. We matched every case of women with shoulder dystocia with ten women giving birth without shoulder dystocia. We compared the maternal demographics and the perinatal outcome between cases and controls.

Results: A total of 1,536 vaginal births were identified over the study period. There were 21 documented cases of shoulder dystocia (1.4% incidence rate) matched with 210 uncomplicated vaginal births. The median age of women with shoulder dystocia was 28 years (IQR = 25–31), 42.9% were nulliparous, and the median gestational age was 39+2 weeks. There was no postpartum hemorrhage, and perineal trauma was comparable between women with and without shoulder dystocia. No neonates with shoulder dystocia were admitted to the neonatal unit and there were no stillbirths. More than 70% of cases with shoulder dystocia occurred during the afternoon and evening hours. The percentage of male neonates was significantly higher in cases with shoulder dystocia (76.2% vs. 51%; p = 0.02). The only independent predictor for shoulder dystocia was birthweight (OR = 1.24; 95% CI, 1.09–1.40).

Conclusion: The incidence of shoulder dystocia and perinatal outcomes are in line with the literature. These local data reflect an efficient maternity service provision and can be used as a benchmark for future comparisons and evaluation, since there is no other similar study within Greek clinical settings that reports on shoulder dystocia.

Klíčová slova: maternal outcome, neonatal outcome, shoulder dystocia, vaginal birth

Vloženo: 28. květen 2025; Revidováno: 13. leden 2026; Přijato: 25. únor 2026; Zveřejněno: 6. březen 2026  Zobrazit citaci

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Chatzipanagiotidou N, Papoutsis D, Valasoulis G, Daponte A. The incidence of and risk factors for shoulder dystocia in a tertiary Greek maternity hospital: a retrospective case-control study. Central European Journal of Nursing and Midwifery. 2026;17(1):2398-2406.
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Reference

  1. American College of Obstetricians and Gynecologists [ACOG]. (2017). Practice bulletin no. 178: shoulder dystocia. Obstetrics & Gynecology, 129(5), e123-133. https://doi.org/10.1097/AOG.0000000000002043 Přejít k původnímu zdroji... Přejít na PubMed...
  2. Antonakou, A., & Papoutsis, D. (2016). The effect of fetal gender on the delivery outcome in primigravidae women with induced labors for all indications. Journal of Clinical and Diagnostic Research, 10(12), QC22-QC25. https://doi.org/10.7860/jcdr/2016/22099.9104 Přejít k původnímu zdroji... Přejít na PubMed...
  3. Buckberry, S., Bianco-Miotto, T., Bent, S. J., Dekker, G. A., & Roberts, C. T. (2014). Integrative transcriptome meta-analysis reveals widespread sex-biased gene expression at the human fetal-maternal interface. Molecular Human Reproduction, 20(8), 810-819. https://doi.org/10.1093/molehr/gau035 Přejít k původnímu zdroji... Přejít na PubMed...
  4. Crofts, J. F., Bartlett, C., Ellis, D., Hunt, L. P., Fox, R., & Draycott, T. J. (2007). Management of shoulder dystocia. Obstetrics & Gynecology, 110(5), 1069-1074. https://doi.org/10.1097/01.aog.0000286779.41037.38 Přejít k původnímu zdroji... Přejít na PubMed...
  5. Davis, D. D., Roshan, A., & Varacallo, M. A. (2023, December 20). Shoulder dystocia. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK470427/
  6. Edwards, A., Megens, A., Peek, M., & Wallace, E. M. (2000). Sexual origins of placental dysfunction. The Lancet, 355(9199), 203-204. https://doi.org/10.1016/s0140-6736(99)05061-8 Přejít k původnímu zdroji... Přejít na PubMed...
  7. Giouleka, S., Tsakiridis, I., Ralli, E., Mamopoulos, A., Kalogiannidis, I., Athanasiadis, A., & Dagklis, T. (2024). Diagnosis and management of macrosomia and shoulder dystocia: a comprehensive review of major guidelines. Obstetrical & Gynecological Survey, 79(4), 233-241. https://doi.org/10.1097/OGX.0000000000001253 Přejít k původnímu zdroji... Přejít na PubMed...
  8. Gurewitsch Allen, E. D. (2016). Recurrent shoulder dystocia: risk factors and counseling. Clinical Obstetrics and Gynecology, 59(4), 803-812. https://doi.org/10.1097/grf.0000000000000229 Přejít k původnímu zdroji... Přejít na PubMed...
  9. Heinonen, K., Saisto, T., Gissler, M., & Sarvilinna, N. (2024). Maternal and neonatal complications of shoulder dystocia with a focus on obstetric maneuvers: a case-control study of 1103 deliveries. Acta Obstetricia et Gynecologica Scandinavica, 103(10). https://doi.org/10.1111/aogs.14780 Přejít k původnímu zdroji... Přejít na PubMed...
  10. Heres, M. H. B., Pel, M., Borkent-Polet, M., Treffers, P. E., & Mirmiran, M. (2000). The hour of birth: comparisons of circadian pattern between women cared for by midwives and obstetricians. Midwifery, 16(3), 173-176. https://doi.org/10.1054/midw.1999.0210 Přejít k původnímu zdroji... Přejít na PubMed...
  11. Hill, D. A., Lense, J., & Roepcke, F. (2020). Shoulder dystocia: managing an obstetric emergency. American Family Physician, 102(2), 84-90.
  12. Jeppegaard, M., Larsen, M. H., Thams, A. B., Schmidt, A. B., Rasmussen, S. C., & Krebs, L. (2024). Incidence of shoulder dystocia and risk factors for recurrence in the subsequent pregnancy - a historical register-based cohort study. Acta Obstetricia et Gynecologica Scandinavica, 103(10), 1975-1984. https://doi.org/10.1111/aogs.14784 Přejít k původnímu zdroji... Přejít na PubMed...
  13. Johansen, L. T., Braut, G. S., Acharya, G., Andresen, J. F., & Øian, P. (2021). How common is substandard obstetric care in adverse events of birth asphyxia, shoulder dystocia and postpartum hemorrhage? Findings from an external inspection of Norwegian maternity units. Acta Obstetricia et Gynecologica Scandinavica, 100(1), 139-146. https://doi.org/10.1111/aogs.13959 Přejít k původnímu zdroji... Přejít na PubMed...
  14. Mannella, P., Palla, G., Cuttano, A., Boldrini, A., & Simoncini, T. (2016). Effect of high-fidelity shoulder dystocia simulation on emergency obstetric skills and crew resource management skills among residents. International Journal of Gynecology & Obstetrics, 135(3), 338-342. https://doi.org/10.1016/j.ijgo.2016.06.023 Přejít k původnímu zdroji... Přejít na PubMed...
  15. Martin, P., Cortina-Borja, M., Newburn, M., Harper, G., Gibson, R., Dodwell, M., Dattani, N., & Macfarlane, A. (2018). Timing of singleton births by onset of labor and mode of birth in NHS maternity units in England, 2005-2014: a study of linked birth registration, birth notification, and hospital episode data. PLoS ONE, 13(6), e0198183. https://doi.org/10.1371/journal.pone.0198183 Přejít k původnímu zdroji... Přejít na PubMed...
  16. Maternal and Child Health Research Consortium. (1998). Focus group: shoulder dystocia. In: Confidential Enquiry Into Stillbirths and Deaths in Infancy (CESDI): 5th annual report.
  17. Mathews, T. J., & Curtin, S. (2015). When are babies born: morning, noon, or night? Birth certificate data for 2013. NCHS Data Brief, 200. National Center for Health Statistics.
  18. Mendez-Figueroa, H., Hoffman, M. K., Grantz, K. L., Blackwell, S. C., Reddy, U. M., & Chauhan, S. P. (2021). Shoulder dystocia and composite adverse otcomes for the maternal-neonatal dyad. American Journal of Obstetrics & Gynecology MFM, 3(4), 100359. https://doi.org/10.1016/j.ajogmf.2021.100359 Přejít k původnímu zdroji... Přejít na PubMed...
  19. Misra, D. P., Salafia, C. M., Miller, R. K., & Charles, A. K. (2009). Non-linear and gender-specific relationships among placental growth measures and the fetoplacental weight ratio. Placenta, 30(12), 1052-1057. https://doi.org/10.1016/j.placenta.2009.09.008 Přejít k původnímu zdroji... Přejít na PubMed...
  20. National Health Service Litigation Authority. (2010). Clinical negligence scheme for trusts: maternity clinical risk management standards 2010. NHS Litigation Authority
  21. Øverland, E. A., Vatten, L. J., & Eskild, A. (2012). Risk of shoulder dystocia: associations with parity and offspring birthweight. A population study of 1 914 544 deliveries. Acta Obstetricia et Gynecologica Scandinavica, 91(4), 483-488. https://doi.org/10.1111/j.1600-0412.2011.01354.x Přejít k původnímu zdroji... Přejít na PubMed...
  22. Papoutsis, D., & Chatzipanagiotidou, N. (2023). A survey on the type and prevalence of medical interventions during labor and childbirth in Greek pregnant women. Clinical and Experimental Obstetrics & Gynecology, 50(12), 258. https://doi.org/10.31083/j.ceog5012258 Přejít k původnímu zdroji...
  23. Papoutsis, D., Klazoglou, P., Valasoulis, G., & Tzavara, C. (2024). The improvement and retention of skills in shoulder dystocia management with the use of high-fidelity simulation: the SAFE (SimulAtion high-FidElity) study. Women and Birth, 37(3), 101590. https://doi.org/10.1016/j.wombi.2024.02.006 Přejít k původnímu zdroji... Přejít na PubMed...
  24. Patumanond, J., Tawichasri, C., & Khunpradit, S. (2010). Infant male sex as a risk factor for shoulder dystocia but not for cephalopelvic disproportion: an independent or confounded effect? Gender Medicine, 7(1), 55-63. https://doi.org/10.1016/j.genm.2010.01.001 Přejít k původnímu zdroji... Přejít na PubMed...
  25. Royal College of Obstetricians and Gynecologists [RCOG]. (2012). Shoulder dystocia: green‑top guideline no. 42 (2nd ed.).
  26. Siassakos, D., Draycott, T., OʼBrien, K., Kenyon, C., Bartlett, C., & Fox, R. (2010). Exploratory randomized controlled trial of hybrid obstetric simulation training for undergraduate students. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 5(4), 193-198. https://doi.org/10.1097/sih.0b013e3181d3ee0b Přejít k původnímu zdroji... Přejít na PubMed...
  27. Tsikouras, P., Kotanidou, S., Nikolettos, K., Kritsotaki, N., Bothou, A., Andreou, S., Nalmpanti, T., Chalkia, K., Spanakis, V., Peitsidis, P., Iatrakis, G., & Nikolettos, N. (2024). Shoulder dystocia: a comprehensive literature review on diagnosis, prevention, complications, prognosis, and management. Journal of Personalized Medicine, 14(6), 586. https://doi.org/10.3390/jpm14060586 Přejít k původnímu zdroji... Přejít na PubMed...

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