Shoulder dystocia: Diagnosis and management

Edwin Chandraharan, Sabaratnam Arulkumaran

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


• Definition: Shoulder dystocia occurs when the baby’s head has been born but a shoulder becomes stuck behind the mother’s pelvic bone, resulting in a delivery that requires additional obstetric manoeuvres to release the shoulder after gentle downward traction has failed. This is a ‘bone–bone problem’ at the level of the pelvis inlet (Figure 12.1).

• Types: Anterior (impaction of anterior shoulder above symphysis pubis). Posterior (impaction of posterior shoulder above sacral promontory).

• Incidence: Approximately 0.5% (5/1000).

• Maternal: Perineal trauma including third-degree perineal tears (3.8%), postpartum haemorrhage (11%) and psychological trauma secondary to traumatic birth experience.

• Fetal: Peripartum hypoxia resulting in stillbirths, neonatal admission for convulsions and multi-organ support, long-term neurological outcomes (learning difficulties, cerebral palsy), neonatal injuries such as fractures (clavicle, humerus), brachial plexus injuries (4–16%), Erb's palsy (10%).

• Medico-legal: clinical negligence claims due to delay in delivery, inappropriate or excessive traction to deliver the shoulders.

Original languageEnglish
Title of host publicationObstetric and Intrapartum Emergencies
Subtitle of host publicationA Practical Guide to Management
PublisherCambridge University Press
Number of pages5
ISBN (Electronic)9780511842153
ISBN (Print)9780521268271
Publication statusPublished - 1 Jan 2012


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