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Delivery Problem: Shoulder Dystocia

 

What is shoulder dystocia?

The word dystocia comes from the Greek word "dys," meaning difficult, and "tokos," meaning childbirth. Shoulder dystocia is a delivery complication when the baby's shoulder (one or both) is stuck behind the mother's pubic bone. This can happen during the pushing phase of labor. There are no signs and no way to prevent the condition from developing. If left untreated, shoulder dystocia can lead to severe complications for the mother and the baby.

There are two types of shoulder dystocia:

1. Spontaneous: This type of shoulder dystocia can happen without any known cause.

2. Predicted or provoked: Predicted or provoked shoulder dystocia happens when there are known risk factors present before labor begins. These risk factors include obesity, short stature, a large baby, and diabetes.

Signs and Symptoms of Shoulder Dystocia

The main symptom of shoulder dystocia is when the baby's head has been delivered, but one or both shoulders remain stuck behind the mother's pubic bone. The baby's head will usually be visible after the delivery charge. Other signs and symptoms of shoulder dystocia include:

  • The baby's head was born but then retracted back into the vagina.
  • The baby's body delivers, but the legs and hips remain flexed.
  • One or both of the baby's arms may extend above the head.
  • There is a decrease in fetal heart rate.
  • Maternal suspects may have stooling or urinary incontinence.

How is shoulder dystocia diagnosed?

Shoulder dystocia is usually diagnosed during delivery. The medical team will assess the situation and determine if the baby's shoulders are stuck. An X-ray may be taken to confirm the diagnosis.

What causes shoulder dystocia?

The exact cause of shoulder dystocia is unknown. However, certain risk factors may increase your chance of developing the condition. These risk factors include:

  • Obesity: Obesity is a body mass index (BMI) of 30 or higher.
  • Short stature: If the mother is 5 feet 2 inches or shorter
  • A large baby: A baby that weighs more than 8 pounds 13 ounces, also called fetal macrosomia.
  • Diabetes: If the mother has diabetes, she may be at an increased risk of delivering a large baby
  • Prolonged labor: If labor lasts longer than 18 hours
  • Previous delivery: If the mother has had a prior delivery with shoulder dystocia
  • Use of forceps or vacuum during delivery: If forceps or vacuum are used during delivery, it may increase the risk of shoulder dystocia
  • Small Pelvic opening: If the mother has a small pelvic space, it may increase the risk of shoulder dystocia.
  • The baby is in the wrong position: If the baby is in a breech position (bottom first), it may increase the risk of shoulder dystocia.
  • The position that limits the room in your pelvis: If you're lying on your back during delivery (called the supine position), it may increase the risk of shoulder dystopia.

What are the complications of shoulder dystocia?

If shoulder dystocia is not treated quickly, it can lead to severe complications for the mother and baby. These complications include:

  • Brachial plexus injury: A brachial plexus is a group of nerves that control shoulder, arm, and hand movement. Damage to these nerves can cause paralysis or weakness in the arm.
  • Fractured humerus: The humerus is the bone in the upper arm. A fracture can occur if too much force is used to deliver the baby's shoulders.
  • Oxygen deprivation: Shoulder dystocia can cause the baby to go without oxygen for too long. This can lead to brain damage or even death.
  • Maternal hemorrhage: Shoulder dystocia can cause the mother to bleed excessively.
  • Uterine rupture: In rare cases, shoulder dystocia can cause the uterus to rupture. This is a life-threatening complication for the mother and baby.
  • Rectovaginal fistula:  Shoulder dystocia can cause a tear in the rectum, bladder, or vagina. This can lead to an abnormal connection (fistula) between these organs.
  • Separation of your pubic bones: In rare cases, the force of shoulder dystocia can cause the pubic bones to separate.

How is shoulder dystocia treated?

Shoulder dystocia is a medical emergency. The goal of treatment is to deliver the baby as quickly and safely as possible. The baby's head must be delivered first to avoid complications. Once the crown is delivered, the medical team will try to deliver the shoulders. If the shoulders cannot be shown, the medical team may need special maneuvers to release them. These maneuvers may include:

  • McRoberts maneuver: The mother is asked to lie on her back and bring her knees up to her chest. This opens up the pelvis and may allow the baby to be delivered.
  • Suprapubic pressure: The medical team will place their hands on the mother's pubic bone and apply pressure. This may help to deliver the baby's shoulders.
  • Posterior arm release: The medical team will deliver the baby's arm behind the body. This may help to provide the baby's other shoulder.
  • Episiotomy: An episiotomy is a surgical incision in the perineum (the area between the vagina and anus) to enlarge the vaginal opening. This procedure can provide more space for delivering the baby and may help prevent other complications, such as tissue tearing.
  • Fetal extraction devices: A variety of devices can help extract a fetus stuck during delivery. One type of device, called a forceps, consists of two curved pieces on either side of the fetal head. Another device, called a vacuum extractor, consists of a suction cup on the fetal head. These devices are generally only used when other methods have failed, and quick delivery is essential to avoid further complications.
  • Cesarean delivery: Shoulder dystocia cannot be resolved in some cases, and a cesarean delivery (also called a C-section) is necessary. This major surgery involves an incision in the abdomen and uterus to deliver the baby via these openings. A C-section may also be necessary if other complicating factors present during labor, such as maternal obesity or diabetes.


After delivery, the medical team will closely monitor the mother and baby. The mother may need special care if she has had a lot of bleeding or other complications. The baby may require special maintenance if he or she has any injuries.

Prevention

Some things can be done to reduce the risk of shoulder dystocia. These include:

  • Proper management of diabetes during pregnancy: Diabetes is a significant risk factor for shoulder dystocia. Women with diabetes should be closely monitored by their healthcare providers during pregnancy.
  • Weight gain: Gaining too much weight during pregnancy can increase the risk of shoulder dystocia. Women should gain only the amount of weight recommended by their healthcare providers.
  • Proper nutrition: Eating a healthy diet and getting enough nutrients during pregnancy can help reduce the risk of shoulder dystocia.
  • Prenatal care: Getting regular prenatal care during pregnancy can help reduce the risk of shoulder dystocia. Healthcare providers can monitor the mother and baby for any potential problems. If you are pregnant, talk to your healthcare provider about ways to reduce your risk of shoulder dystocia.


Shoulder dystocia is a severe delivery complication that can have lifelong consequences for both the mother and baby. Awareness of the risk factors and signs of shoulder dystocia is essential. If pregnant, talk to your healthcare provider about reducing your risk. If shoulder dystocia occurs during delivery, it is necessary to get to a hospital as soon as possible so that the medical team can take action to resolve the complication.




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