Shoulder dystocia

Shoulder dystocia


Caption =
DiseasesDB = 12036
ICD10 = ICD10|O|66|0|o|60
ICD9 = ICD9|660.4
MedlinePlus =
eMedicineSubj =
eMedicineTopic =
MeshID =

Shoulder dystocia is a specific case of dystocia whereby after the delivery of the head, the anterior shoulder of the infant cannot pass below the pubic symphysis, or requires significant manipulation to pass below the pubic symphysis. It is diagnosed when the shoulders fail to deliver shortly after the fetal head. In shoulder dystocia, it is the chin that presses against the walls of the perineum [cite book |last= Kish|first= Karen|coauthors= Joseph V. Collea|editor= Alan H. DeCherney|others= Lauren Nathan|title= Current Obstetric & Gynecologic Diagnosis & Treatment|accessdate= 2008-06-16|accessyear= |accessmonth= |edition= Ninth Edition|year= 2003|month= |publisher= Lange/McGraw-Hill|isbn= 0-07-118207-1|pages= 381-382|chapter= Malpresentation & Cord Prolapse (Chapter 21)]


A number of obstetrical maneuvers are sequentially performed in attempt to facilitate delivery at this point, including :

*Gaskin maneuver, named after Certified Professional Midwife, Ina May Gaskin, involves moving the mother to an all fours position with the back arched, widening the pelvic outlet.

* McRobert's maneuver;cite journal |author=Stallard TC, Burns B |title=Emergency delivery and perimortem C-section |journal=Emerg. Med. Clin. North Am. |volume=21 |issue=3 |pages=679–93 |year=2003 |pmid=12962353 |doi=10.1016/S0733-8627(03)00042-7] [cite book |last= Kish|first= Karen|coauthors= Joseph V. Collea|editor= Alan H. DeCherney|others= Lauren Nathan|title= Current Obstetric & Gynecologic Diagnosis & Treatment|accessdate= 2008-06-16|accessyear= |accessmonth= |edition= Ninth Edition|year= 2003|month= |publisher= Lange/McGraw-Hill|isbn= 0-07-118207-1|pages= 382|chapter= Malpresentation & Cord Prolaps (Chapter 21)]

* suprapubic pressure (or Rubin I)cite web |url= |title=Shoulder Dystocia Management |accessdate=2007-11-28 |format= |work=]

* Rubin II or posterior pressure on the anterior shoulder, which would bring the fetus in an oblique position with head somewhat towards the vaginacite web |url= |title=Shoulder Dystocia - April 1, 2004 - American Family Physician |accessdate=2007-11-28 |format= |work=]

* Woods' screw maneuver which leads to turning the anterior shoulder to the posterior and vice versa (somewhat the opposite of Rubin II maneuver)cite web |url= |title=Fetal Dystocia: Abnormalities and Complications of Labor and Delivery: Merck Manual Professional |accessdate=2007-11-28 |format= |work=]

* Jacquemier's maneuver (also called Barnum's maneuver), or delivery of the posterior shoulder first, in which the forearm and hand are identified in the birth canal, and gently pulled.

More drastic maneuvers include
* Zavanelli's maneuver, which involves pushing the fetal head back in with performing a cesarean section.cite journal |author=Fernandez H, Papiernik E |title= [The Zavanelli maneuver: use during breech retention of the head in the birth canal. Apropos of a case] |language=French |journal=J Gynecol Obstet Biol Reprod (Paris) |volume=19 |issue=4 |pages=483–5 |year=1990 |pmid=2380511 |doi=] or internal cephalic replacement followed by Cesarean section

* intentional clavicular fracture, which reduces the diameter of the shoulder girdle that requires to pass through the birth canal.

* symphisiotomy, which makes the opening of the birth canal laxer by breaking the connective tissue between the two pubes bones facilitating the passage of the shoulders.

* abdominal rescue, described by O'Shaughnessy, where a hysterotomy facilitates vaginal delivery of the impacted shouldercite journal |author=O'Shaughnessy MJ |title=Hysterotomy facilitation of the vaginal delivery of the posterior arm in a case of severe shoulder dystocia |journal=Obstet Gynecol |volume=92 |issue=4 Pt 2 |pages=693–5 |year=1998 |pmid=9764668 |doi=10.1016/S0029-7844(98)00153-7]

Risk factors

Although the definition is imprecise, it occurs in approximately 1% of vaginal births. There are well-recognised risk factors, such as diabetes,cite journal |author=Jouatte F, Aitken B, Dufour P, "et al" |title= [Diabetes before pregnancy, apropos of 143 cases] |language=French |journal=Contracept Fertil Sex |volume=27 |issue=12 |pages=845–52 |year=1999 |pmid=10676041 |doi=] fetal macrosomia, and maternal obesity, but it is often difficult to predict [Breeze AC, Lees CC (2004). Managing shoulder dystocia. "Lancet" 364, 2160-1 [] ] . Despite appropriate obstetric management, fetal injury (such as brachial plexus injury) or even fetal death can be a complication of this obstetric emergency.

Recurrence rates are relatively high and low most of the short time.cite journal |author=Gurewitsch ED, Johnson TL, Allen RH |title=After shoulder dystocia: managing the subsequent pregnancy and delivery |journal=Semin. Perinatol. |volume=31 |issue=3 |pages=185–95 |year=2007 |pmid=17531900 |doi=10.1053/j.semperi.2007.03.009]


ee also

* Klumpke paralysis
* Erb's Palsy

External links


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