Improving Risk Assessment of Shoulder Dystocia - CALM Shoulder Screen™
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Did you know?
"ACOG data shows that shoulder dystocia claims
account for 17% of all obstetrical claims"
- Health Systems Risk Management Advisor, July 2005
- Shoulder dystocia with neonatal injury occurs in about 0.4 to 3 vaginal births per 1000;
- Short mothers, maternal obesity and large babies are the principal risk factors;
- Rates of maternal obesity (a risk factor) are increasing;
- Medical liability payouts for a baby with subsequent disability average around $500,000.
The Main Issues
"There's little data to show which maneuver is more effective
at alleviating shoulder dystocia without injury"
- ACOG Today, August 2005
Existing guidelines recommend consideration of elective cesarean when estimated fetal weight is greater than 5000g, or over 4500g in the presence of maternal diabetes. These guidelines are generally followed and do detect the babies at highest risk.
The average fetal weight of babies experiencing shoulder dystocia with injury is around 4000g.
The CALM Shoulder Screen™ Program
Now physicians can assess the risk of shoulder dystocia on behalf of their patients.
- Before the onset of labor;
- Using easily available measures;
- Providing a good balance between sensitivity and false positives.
"When tested in an independent series of over 200 cases of shoulder
dystocia that went to litigation, CALM Shoulder Screen detected
61% of cases with permanent brachial plexus injury."
CALM Shoulder Screen (patent pending) is a program to assess the risk of shoulder dystocia with injury. The algorithm is based on anthropometric maternal and fetal characteristics. Depending upon preferred thresholds, its detection rates between 30% and 61% could translate to multi-million dollar savings for large hospital systems or insurers.
Key Benefits
- Assesses risk of shoulder dystocia with injury at or before the onset of labor;
- Uses easily available measures;
- Greatly improves detection rate with a relatively small increase in the rate of cesarean;
- Enables clinical teams to communicate risk effectively to patients when recommending a course of action;
- Provides institutions with the ability to select appropriate thresholds for their respective practices.
Click to enlarge
View of patient's assessment for risk of Shoulder Dystocia.
Key Features
- Risk assessment can be performed from 37 weeks of gestation onward;
- Web based;
- HIPAA compliant;
- Accessible from the physician's office or from the hospital;
- Easy to use, print and save;
- Builds individual or institutional database;
- Provides links to useful information;
Applications
- Prospectively at the onset of labor
- Retrospectively in quality review
Evolving Best Practices to Avoid Shoulder Dystocia
Given CALM Shoulder Screen's excellent sensitivity and easy of use in identifying a substantial portion of deliveries at risk for permanent injury on the infant from the shoulder dystocia, we feel that CALM Shoulder Screen will soon become a mainstream risk reduction strategy for obstetrics.
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