Shoulder dystocia

Shoulder Dystocia
ShoulderDystociaFig1.jpg
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Difficulty delivering the shoulders after the head has emerged
Complications	Brachial plexus injury, clavicle fracture, hypoxia
Onset	During childbirth
Duration	Acute
Types	N/A
Causes	Fetal macrosomia, maternal diabetes, obesity
Risks	Previous shoulder dystocia, prolonged labor
Diagnosis	N/A
Differential diagnosis	N/A
Prevention	N/A
Treatment	McRoberts maneuver, suprapubic pressure
Medication	N/A
Prognosis	Generally good with prompt management
Frequency	N/A
Deaths	N/A

Shoulder dystocia is an obstetric emergency that occurs when, after the delivery of the fetal head, the anterior shoulder of the infant cannot pass below, or requires significant manipulation to pass below, the pubic symphysis. This condition can lead to significant complications for both the mother and the infant if not managed promptly and effectively.

Pathophysiology

Shoulder dystocia occurs when the fetal shoulders fail to deliver spontaneously after the head has emerged. This is often due to the anterior shoulder becoming impacted behind the maternal pubic symphysis. The condition is more common in cases of fetal macrosomia, where the infant is larger than average, and in mothers with gestational diabetes or obesity.

Risk Factors

Several factors increase the risk of shoulder dystocia, including:

• Fetal macrosomia
• Maternal diabetes
• Obesity
• Prolonged second stage of labor
• Previous history of shoulder dystocia

Complications

Complications from shoulder dystocia can be severe and include:

• Brachial plexus injury
• Clavicle fracture
• Hypoxia or asphyxia
• Maternal postpartum hemorrhage

File:ClavicleFractureSD.jpg

Clavicle fracture as a result of shoulder dystocia

Management

The management of shoulder dystocia involves a series of maneuvers designed to free the impacted shoulder and allow for the safe delivery of the infant. These include:

McRoberts Maneuver

File:McRoberts maneuver.svg

McRoberts maneuver

The McRoberts maneuver involves hyperflexing the mother's legs tightly to her abdomen, which can help to change the angle of the pelvis and free the impacted shoulder.

Suprapubic Pressure

File:Suprapubic-pressureforSD.jpg

Suprapubic pressure being applied

Suprapubic pressure is applied to the lower abdomen to help dislodge the anterior shoulder from behind the pubic symphysis.

Other Maneuvers

Other maneuvers that may be employed include the Woods' screw maneuver, delivery of the posterior arm, and the Rubin maneuver.

Prognosis

With prompt and effective management, the prognosis for shoulder dystocia is generally good. However, the risk of complications such as brachial plexus injury remains, and careful monitoring and follow-up are essential.

Also see

• Brachial plexus injury
• Fetal macrosomia
• Gestational diabetes
• Obstetric emergencies