• 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.
|Title of host publication||Obstetric and Intrapartum Emergencies|
|Subtitle of host publication||A Practical Guide to Management|
|Publisher||Cambridge University Press|
|Number of pages||5|
|Publication status||Published - 1 Jan 2012|