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Objective: The objective of the study was to identify recurrent shoulder dystocia risk factors., Study Design: This was a population-based case-control study in Washington state (1987-2004). Primary and recurrent shoulder dystocia incidences were calculated. Logistic regression was used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for subsequent shoulder dystocia risk factors., Results: Primary and recurrent shoulder dystocia annual incidences were 2.3 of 100 and 13.5 of 100. Of 26,208 women with shoulder dystocia deliveries, 8991 had subsequent vaginal births, and of those, 1060 (11.8%) had a recurrent shoulder dystocia. Index pregnancy birthweight was associated with an increased risk of subsequent shoulder dystocia: 3500-3999 g, aOR 1.8 (95% CI 1.5 to 2.3); 4000-4499 g, aOR 3.3 (95% CI 2.6 to 4.1); 4500-4999 g, aOR 3.1 (95% CI 2.3 to 4.3); and 5000 g or greater, aOR 3.8 (95% CI 2.0 to 7.3). Vacuum delivery, aOR 1.4 (95% CI 1.2 to 1.7), and severe shoulder dystocia, aOR 2.1 (95% CI 1.6 to 2.7) in the index delivery, were also significant., Conclusion: Birthweight of 3500 g or greater, vacuum delivery, or severe shoulder dystocia in the index delivery were independent risk factors for shoulder dystocia recurrence.

Objective: Ventricular septal defect (VSD) is currently the most common congenital cardiac malformation in the United States, but little is known about its etiology. The objective of this study was to address the hypothesis that parents' residence in eastern Washington, a region heavily dominated by the agricultural industry, and employment in agriculturally related occupations can influence the presence of a VSD in their offspring., Design: Population-based case-control study., Setting: Washington State from January 1, 1987, through December 31, 2003., Patients: Children aged 0 to 2 years diagnosed as having a VSD (n = 3489), and other infants selected at random as control subjects (n = 13 290)., Main Exposures: Parental occupation and county of maternal residence were obtained from the birth certificate. The latter was categorized according to region (east vs west), rural-urban classification, and the proportion of farm and crop land., Main Outcome Measures: Diagnosis of VSD within the first 2 years of life., Results: The risk of VSD was greater for infants whose mothers resided in eastern Washington (odds ratio, 1.30; 95% confidence interval, 1.03-1.65). The risk of VSD with other cardiac malformations (n = 1205) exhibited a stronger geographic association than did isolated VSD (n = 2284). Analyses restricted to eastern Washington did not reveal a clear relationship between the risk of VSD and an increasing proportion of agricultural land in the mother's county of residence. Parental occupation in agriculture was not associated with the presence of VSD., Conclusion: Although these findings suggest regional variation in Washington State in the occurrence of VSD, the basis for this variation remains to be determined.

Objective: The purpose of this study was to compare maternal and neonatal morbidity among Somali immigrants, US-born blacks and whites in Washington state., Study Design: Washington state birth certificate data was linked to hospital discharge records comparing singleton deliveries among Somali immigrants with US-born blacks and whites between 1993 and 2001, in a 1:3 ratio. Outcomes were compared using unconditional multiple logistic regression models calculating odds ratios (ORs), and 95% confidence intervals (95% CIs)., Results: Five hundred seventy-nine pregnancies from Somali women were compared with 2384 and 2435 pregnancies from black and white women, respectively. Nulliparous Somali women were more likely to have a cesarean delivery than black or white control women, OR 1.6 (95% CI, 1.1-2.3) and 2.0 (95% CI, 1.4-2.8), respectively. Among all women who had cesarean deliveries, Somali women more commonly had cesarean deliveries associated with fetal distress and failed induction of labor. They were 9 times more likely than both control groups to deliver after 42 weeks gestation, and 4 times more likely than black women and 8 times more likely than white women to have oligohydramnios. Somali women were more likely to have gestational diabetes and significant perineal lacerations, and less likely to smoke. Newborns of Somali women were at increased risk for prolonged hospitalization, lower 5-minute Apgar scores, assisted ventilation, and meconium aspiration., Conclusion: Pregnancy outcomes should be evaluated within ethnically and culturally unique groups; Somali immigrants are a high-risk subpopulation.