Acrobat
MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Shoulder Dystocia
Sponsored by The Indian Health Service Clinical Support Center
2. Background
Clinical Features
Shoulder dystocia
is a true obstetric emergency that will eventually be faced by anyone who attends births. As with other emergency situations, it is good to have a drill and review it several times a year to stay prepared. You can never tell when it will be your turn to deal with it! All prenatal care providers should also be familiar with the risk factors for shoulder dystocia, but, in reality, all schemes to predict or prevent it miss over 80% of the cases, thus reinforcing the need for preparedness.
Shoulder dystocia (Gherman1) (Gherman2) (Wagner) is in reality an “orthopedic” problem. It is defined as failure of the fetal shoulders to descend past the pelvic outlet following delivery of the head. The problem is actually an impaction of the anterior fetal shoulder behind the maternal pubis. Understanding this concept will help you understand how to relieve the problem. During the time the fetus is impacted, its umbilical cord is occluded. Severe asphyxial injury or death may result if the situation is not relieved promptly. Likewise, the maneuvers to achieve delivery may result in fetal injury, including fractures of the clavicle and humerus, and brachial plexus injury (see Table 1), as will be discussed further below.
Table 1 |
Complications of Shoulder Dystocia |
MaternalPostpartum hemorrhage |
FetalBrachial plexus palsy |
