Abstract
• 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 language | English |
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Title of host publication | Obstetric and Intrapartum Emergencies |
Subtitle of host publication | A Practical Guide to Management |
Publisher | Cambridge University Press |
Pages | 88-92 |
Number of pages | 5 |
ISBN (Electronic) | 9780511842153 |
ISBN (Print) | 9780521268271 |
DOIs | |
Publication status | Published - 1 Jan 2012 |