Is An Episiotomy Necessary With A Shoulder Dystocia

American Journal of Obstetrics and Gynecology, 04/25/2011

Paris AE et al. – Despite historical recommendations for an episiotomy to prevent brachial plexus injury when a shoulder dystocia is encountered, the trend authors observed does not suggest benefit from this practice.


  • All births at Brigham and Women’s Hospital from September 1, 1998 through August 31, 2009 were reviewed.
  • Total number of births, mode of delivery, shoulder dystocias, episiotomies with and without shoulder dystocias, and brachial plexus injuries were recorded.
  • A non-parametric test of trend was performed.
  • There were a total of 94,842 births, 953 shoulder dystocias and 102 brachial plexus injuries.


  • The rate of episiotomy with shoulder dystocia dropped from 40% in 1999 to 4% in 2009 (p=0.005) with no change in the rate of brachial plexus injuries per 1000 vaginal births.

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