Shoulder dystocia: Difference between revisions

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= Shoulder Dystocia =
{{Infobox medical condition
| name = Shoulder Dystocia
| image = ShoulderDystociaFig1.jpg
| caption = Diagram illustrating shoulder dystocia
| field = Obstetrics
| symptoms = Difficulty delivering the shoulders after the head has emerged
| complications = Brachial plexus injury, clavicle fracture, hypoxia
| onset = During childbirth
| duration = Acute
| causes = Fetal macrosomia, maternal diabetes, obesity
| risks = Previous shoulder dystocia, prolonged labor
| treatment = McRoberts maneuver, suprapubic pressure
| prognosis = Generally good with prompt management
}}


Shoulder dystocia is a critical and emergency obstetric condition that occurs when the baby's anterior shoulder gets stuck behind the mother's symphysis pubis during childbirth. This complication requires immediate and skilled intervention to safely deliver the baby without causing harm to the mother or the infant.
'''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.


[[File:Suprapubic-pressureforSD.jpg|thumb|Illustration depicting the management of shoulder dystocia during childbirth.]]
==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 ==
==Risk Factors==
Several factors can increase the risk of shoulder dystocia, including:
Several factors increase the risk of shoulder dystocia, including:
- Maternal diabetes
* Fetal macrosomia
- Obesity in the mother
* Maternal diabetes
- History of shoulder dystocia in previous deliveries
* Obesity
- Post-term pregnancy
* Prolonged second stage of labor
- Excessive weight gain during pregnancy
* Previous history of shoulder dystocia
- Large fetal size (macrosomia)


<youtube>
==Complications==
title='''{{PAGENAME}}'''
Complications from shoulder dystocia can be severe and include:
movie_url=http://www.youtube.com/v/BvkKMwDaryg
* [[Brachial plexus injury]]
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* [[Clavicle fracture]]
embed_source_url=http://www.youtube.com/v/BvkKMwDaryg
* Hypoxia or asphyxia
&rel=1
* Maternal postpartum hemorrhage
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</youtube>


== Signs ==
[[File:ClavicleFractureSD.jpg|thumb|Clavicle fracture as a result of shoulder dystocia]]
The hallmark sign of shoulder dystocia during delivery is the failure of the shoulders to deliver shortly after the fetal head, leading to a sudden halt in delivery progress. This situation is often recognized by the "turtle sign," where the baby's head retracts against the mother’s perineum after the initial emergence.


== Management ==
==Management==
Management of shoulder dystocia requires prompt and effective interventions to minimize the risk of injury to both the mother and the baby. Common maneuvers include:
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''': Flexing the mother’s thighs onto her abdomen to widen the pelvis.
- '''Suprapubic Pressure''': Applying pressure above the pubic bone to help dislodge the baby’s shoulder.
- '''Delivery of the Posterior Arm''': Reaching into the vagina to rotate and deliver the baby's posterior arm.
- '''Episiotomy''': Making a surgical cut in the perineum to enlarge the vaginal opening.


Healthcare providers may need to use a combination of these maneuvers to resolve the situation.
===McRoberts Maneuver===
[[File:McRoberts maneuver.svg|thumb|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.


== Complications ==
===Suprapubic Pressure===
Shoulder dystocia can lead to several complications if not managed promptly, including:
[[File:Suprapubic-pressureforSD.jpg|thumb|Suprapubic pressure being applied]]
- Brachial plexus injury, leading to temporary or permanent arm weakness or paralysis in the newborn.
Suprapubic pressure is applied to the lower abdomen to help dislodge the anterior shoulder from behind the pubic symphysis.
- Fractures of the clavicle or humerus in the newborn.
- Hypoxia or brain damage due to prolonged delivery.
- Hemorrhage or significant tearing in the mother.


== Prevention ==
===Other Maneuvers===
Preventive measures for shoulder dystocia are limited due to its unpredictable nature but may include:
Other maneuvers that may be employed include the Woods' screw maneuver, delivery of the posterior arm, and the Rubin maneuver.
- Careful monitoring of maternal and fetal risk factors during pregnancy.
- Consideration of elective cesarean delivery for known risk factors such as fetal macrosomia or a history of shoulder dystocia.
- Preparing for the possibility of shoulder dystocia in high-risk deliveries by having an experienced team available.


== External Links ==
==Prognosis==
* [https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/08/shoulder-dystocia American College of Obstetricians and Gynecologists - Shoulder Dystocia]
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.
* [https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg42/ Royal College of Obstetricians and Gynaecologists - Shoulder Dystocia]


== References ==
==Also see==
<references />
* [[Brachial plexus injury]]
* [[Fetal macrosomia]]
* [[Gestational diabetes]]
* [[Obstetric emergencies]]
 
{{Obstetrics}}


[[Category:Obstetrics]]
[[Category:Obstetrics]]
[[Category:Childbirth]]
[[Category:Medical emergencies]]
[[Category:Medical emergencies]]
{{stub}}

Latest revision as of 02:52, 11 December 2024

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[edit]

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[edit]

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[edit]

Complications from shoulder dystocia can be severe and include:

File:ClavicleFractureSD.jpg
Clavicle fracture as a result of shoulder dystocia

Management[edit]

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[edit]

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[edit]

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[edit]

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

Prognosis[edit]

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[edit]



Obstetrics
Fundamentals
Conditions and Disorders
Procedures
Tests and Research
Related Fields
This obstetrics-related article is a stub.
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