What risk factor is associated with the highest risk for shoulder dystocia?

The risk factor that is associated with the highest risk for shoulder dystocia is previous shoulder dystocia. This is significant because having experienced a previous incident of shoulder dystocia increases the likelihood of recurrence in subsequent deliveries. The mechanisms underlying this increased risk may involve anatomical factors such as pelvic shape or size, maternal soft tissue changes, or patterns of fetal growth from one pregnancy to another.

While other factors like maternal diabetes, fetal macrosomia, and having a male fetus are known to contribute to the risk of shoulder dystocia, they do not have the same level of direct correlation as a history of prior shoulder dystocia. Each of these conditions can increase the chances of a shoulder dystocia occurrence, particularly because they often lead to larger fetal sizes, but they don’t necessarily indicate a greater risk in the same direct way. A history of shoulder dystocia serves as a critical warning sign for healthcare providers, signaling that specific precautions may be necessary during labor and delivery to prevent another episode.