Contents lists available at sciencedirect european journal. Shoulder dystocia occurs during vaginal birth when, after birth of the fetuss head, one or both shoulders are impacted against the bones of the mothers pelvis. Similarly, the available literature suggests that delivery of the posterior arm should be prioritized. Studies have shown that prepregnancy, antepartum, and intrapartum risk factors have extremely poor predictive value for shoulder dystocia. Episiotomy episiotomy is an option that may facilitate the woods.
Kleitman 2016 reported that previous shoulder dystocia was found to be an independent risk factor for recurrent shoulder dystocia with an odds ratio of 6. Although fetal macrosomia and maternal diabetes are risk factors for shoulder dystocia, for the most part. While the cause of shoulder dystocia is unknown, several risk factors have been identified. Shoulder dystocia occurs when the descent of the anterior shoulder is obstructed by the symphysis pubis or impaction of the posterior shoulder. Dystocia difficult or obstructed labor2 encompasses a variety of concepts, ranging from abnormally slow dilation of the cervix or descent of the fetus during active labor3 to entrapment of the fetal shoulders after delivery of the head shoulder dystocia, an obstetric emergency. Other risk factors of shoulder dystocia include maternal diabetes, previous shoulder dystocia, maternal obesity, prolonged labor and induction of labor 69. Shoulder dystocia is, by definition, a mechanical problem occurring during a vaginal delivery. Ten years of simulationbased shoulder dystocia training. Dystocia difficult or obstructed labor 2 encompasses a variety of concepts, ranging from abnormally slow dilation of the. The babys head has been born but the shoulders are stuck.
If this happens, extra help is usually needed to release the babys shoulder. However, as time passes and a shoulder dystocia remains unresolved for 4 or 5 minutes, the risk of neurologic injury and fetal death increases. Traction on the head can damage the brachial plexus. A prior history of delivery complicated by shoulder dystocia confers a 6fold to nearly 30fold increased risk of shoulder dystocia recurrence in a subsequent vaginal delivery, with most reported. Populationbased risk factors for shoulder dystocia. It occurs when one or both shoulders becomes impacted against the bones of the maternal pelvis, as shown in the image below. Strategies to improve management of shoulder dystocia. Shoulder dystocia shrooti shah lecturer national medical college nursing campus 2.
Guideline for the management of shoulder dystocia hse. Bilateral fractures in a shoulder dystocia delivery bmj. Definition when fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia. Shoulder dystocia sd occurs when a babys head is delivered vaginally, but their shoulders get stuck in the mothers body 1. Failure of the shoulders to traverse the pelvis spontaneously after delivery of the head. The ada advises screening pregnant women in their first trimester if they have risk factors for developing. The nurse midwife was actually present during the mothers three previous deliveries in which shoulder dystocia occurred in two. Shoulder dystocia is defined as a vaginal cephalic delivery that requires additional obstetric. The shoulder become trapped against the mothers pubic bone. In the majority of cases, the baby will be born promptly and. This video demonstrates the maps sequence of manoeuvres mcroberts, anterior shoulder, posterior shoulder, and salvage for the management of shoulder dystocia.
Bilateral fractures in a shoulder dystocia delivery. Shoulder dystocia is an unpredictable and unpreventable obstetric emergency that places the pregnant woman and fetus at risk of injury. Taskforceandworkgroupreportsneonatalbrachialplexuspalsy. A posterior axilla maneuver can be performed more rapidly than. Shoulder dystocia, erbs palsy, and birth injury lawsuits. Shoulder dystocia sd is defined as a vaginal delivery in cephalic. A vaginal delivery is complicated by shoulder dystocia when, after delivery of the fetal head, additional obstetric maneuvers beyond gentle traction are needed to enable delivery of the fetal shoulders. Johns hopkins medicine ob shoulder dystocia team simulation course evaluation.
When shoulder dystocia occurs after instrumental vaginal delivery, the chance. Shoulder dystocia is clinically diagnosed when gentle downward traction fails, requiring additional obstetric maneuvers to accomplish delivery of the fetal shoulders. Charlene is a 31 yearold g1 woman at 40 weeks and 6 days gestation as determined by in vitro fertilization dating, who presents with a chief complaint of contractions. Predictive factors for the success of mcroberts manoeuvre and. Practical obstetric multiprofessional training course manual. Abnormal positioning includes shoulder dystocia where the. Shoulder dystocia is when, after delivery of the head, the babys anterior shoulder gets caught above the mothers pubic bone. Discuss strategies for emergency management of breech presentation, shoulder dystocia and cord prolapse. The dominant maneuver to solve the shoulder dystocia changed from posterior arm extraction to internal rotation of the anterior shoulder between the pre and postprobe groups. Fourth edition of the alarm international program shoulder dystocia chapter page 9. It appears from the literature that the risk of recurrent shoulder dystocia is substantial. Shoulder dystocia is a severe and highly unpredictable complication that occurs in approximately 0. In the united states, the prevalence of many known and suspected risk factors for shoulder dystocia is increasing.
Shoulder dystocia can lead to death or brain damage for the baby. Despite its low incidence, sd still represents a huge risk of morbidity for both the mother and fetus. A vaginal delivery is complicated by shoulder dystocia when, after. An objective diagnosis of a prolongation of headtobody delivery time of more than 60 seconds has also been proposed, but these data are not routinely collected. The available literature demonstrates clear value in both simulation training and having a clear algorithmic approach. Discuss the labor and delivery nurses role in managing shoulder dystocia. Bilateral fractures in a shoulder dystocia delivery timothy shao ern tan, abida mohamed, sandeep dharmaraj department of neonatology, lancashire teaching hospitals nhs foundation trust, preston, uk correspondence to dr timothy shao ern tan, timothy. According to acog american college of obstetrics and gynecology, the reported incidence of shoulder dystocia among vaginal deliveries range from 0.
The entrapment of the infants shoulders, after the delivery of the head, is an emergency. Signs include retraction of the babys head back into the vagina, known as turtle sign. Signs include retraction of the babies head back into the vagina, known as turtle sign. A male neonate weighing 4170 g 99th centile was born to a nondiabetic primigravid woman by difficult vaginal delivery at 37 weeks gestation due to right shoulder dystocia. Shoulder dystocia is defined as a vaginal cephalic delivery that requires additional obstetric manoeuvres to deliver the fetus after the head has delivered and gentle traction has failed. Both the size and the position of the fetus can lead to obstructed labor.
When shoulder dystocia is diagnosed, the standard management is similar to that proposed in the alarm course. Shoulder dystocia simulation and training videos johns. It is a delivery complication that requires additional obstetric maneuvers to. Shoulder dystocia is when the babys head has been born but one of the shoulders becomes stuck behind the mothers pubic bone, delaying the birth of the babys body. Shoulder dystocia shoulder dystocia can be one of the most frightening emergencies in the delivery room although many factors have been associated with shoulder dystocia, most cases occur with no warning defined as a delivery in which additional maneuvers are required to deliver the fetus after normal gentle downward traction has. Apart from maternal obesity body mass index of 36 kgm2, no other risk factors for fetal macrosomia or shoulder dystocia were. Shoulder dystocia is a complication of vaginal delivery and the primary factor associated with brachial plexus injury. According to the centers for disease control and prevention, 20 x centers for disease control and prevention, 20 centers for disease control and prevention. Bmc pregnancy and childbirth volume 16, article number.
Similarly, the available literature suggests that delivery of the posterior. Maternity guideline shoulder dystocia gl9 march 2016 complete a clinical incident form and enter its number onto the shoulder dystocia report form. Shoulder dystocia was first described in 1730 and is an uncommon obstetric complication of cephalic vaginal deliveries during which the fetal shoulders do not deliver after the head has emerged from the mothers introitus. We are committed to sharing findings related to covid19 as quickly and safely as possible. We will be providing unlimited waivers of publication charges for accepted articles related to covid19. Guideline for the management of shoulder dystocia hse home birth service revision no. The rate of brachial plexus injuries in deliveries complicated with shoulder dystocia was 73% preprobe compared to 17% in the late postprobe group p 0. In the first, the shoulders are disimpacted by rocking them through the mothers abdominal wall, with the hope that they then will find a more favorable diameter for descent. Namak s, beck k, mertz h, lord r 2016 axillary digital traction maneuver. Even though several studies showed the existence of both major and minor risk factors that may complicate a delivery, sd remains an unpreventable and unpredictable obstetric emergency. In resolving a shoulder dystocia, speed and skill are essential.
Intrauterine fetal death and risk of shoulder dystocia at. Pdf shoulder dystocia is a complication of vaginal delivery and the primary factor associated with brachial plexus injury. Delivering shoulders and dealing with shoulder dystocia. Approximately 80% of american women will eventually have at least one child, 1 and the majority of these women will undergo labor. Shoulder dystocia in primary midwifery care in the netherlands. Complications for the mother may include vaginal or perineal tears, postpartum bleeding, or. The labour was induced and neville barnes forceps were employed for successful delivery. Complications for the baby may include brachial plexus injury or clavicle fracture. Maternal obesity should be addressed before pregnancy whenever possible as substantial. Home december 2016 volume 59 issue 4 shoulder dystocia.
Two helpful maneuvers for managing shoulder dystocia, a common cause of fetal injury, are not described in obstetrical texts. Shoulder dystocia continues to challenge obstetrical providers and therefore the management must evolve. Shoulder dystocia sd is the nightmare of obstetricians. Similarly, the available literature suggests that delivery of. This prevents the doctor from fully delivering the baby and can extend the length of time for delivery. Shoulder dystocia occurs when a babys head passes through the birth canal and their shoulders become stuck during labor.
1027 336 353 605 1117 456 20 577 1556 495 597 1055 1216 1210 272 1428 1463 1556 1012 991 684 360 786 539 559 1109 637 907 1575 1535 719 1110 239 424 633 420 998 1037 1130 181 1001 1210 1401 472 61