North American Registry of Midwives (NARM) Practice Exam

What is Varney's predictive factor for shoulder dystocia?

1. An estimated fetal weight of 1 pound or more greater than the woman's largest baby

2. Previous shoulder dystocia incidents

3. Maternal age over 35

4. Use of epidural anesthesia

The correct answer is: An estimated fetal weight of 1 pound or more greater than the woman's largest baby

The correct choice highlights that an estimated fetal weight that is 1 pound or more greater than the woman's largest baby is a predictive factor for shoulder dystocia. This relates to the significant correlation between fetal size and delivery complications. When a fetus is larger than previous offspring, it increases the risk of shoulder dystocia due to the potential for broader shoulders, which might struggle to navigate through the pelvic inlet during birth. Identifying fetal macrosomia is critical during prenatal assessments, as it prompts healthcare providers to consider the likelihood of complications such as shoulder dystocia and to plan accordingly for labor and delivery. In contrast, while previous shoulder dystocia incidents do indeed increase the risk of recurrence, they are not a universal predictive factor, as situations can differ with each pregnancy. Maternal age over 35 can be associated with various risks in pregnancy but is not a direct predictor for shoulder dystocia. Likewise, while epidural anesthesia can influence the dynamics of labor, it is not a direct indicator of shoulder dystocia risk. Therefore, considering the fetal weight in relation to past births stands out as a validated predictive factor in clinical practice.