Shoulder presentation

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Shoulder presentation is a type of malpresentation in which the fetus is positioned with its shoulder pointing towards the birth canal. This condition is a form of transverse lie, where the fetus lies horizontally in the uterus rather than the typical cephalic presentation (head-first) or breech presentation (buttocks or feet first).

Causes

Shoulder presentation can be caused by several factors, including:

• Multiple pregnancy (twins or more)
• Polyhydramnios (excessive amniotic fluid)
• Uterine abnormalities such as fibroids or congenital malformations
• Placenta previa, where the placenta covers the cervix
• Premature labor, where the fetus has not yet assumed the head-down position

Diagnosis

Shoulder presentation is typically diagnosed through:

• Physical examination: The healthcare provider may feel the shoulder during a pelvic exam.
• Ultrasound: Imaging can confirm the position of the fetus.
• Leopold's maneuvers: A series of abdominal palpations to determine fetal position.

Complications

Shoulder presentation can lead to several complications, including:

• Obstructed labor
• Increased risk of cesarean section
• Umbilical cord prolapse
• Fetal distress

Management

Management of shoulder presentation may involve:

• Attempting an external cephalic version (ECV) to turn the fetus to a head-down position.
• Planning for a cesarean section if the fetus cannot be repositioned.
• Close monitoring of the pregnancy to manage any arising complications.

See also

• Cephalic presentation
• Breech presentation
• Transverse lie
• External cephalic version
• Cesarean section

External links

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