Shoulder dystocia
Shoulder dystocia is when, after vaginal delivery of the head, the baby's anterior shoulder gets caught above the mother's pubic bone. Signs include retraction of the baby's head back into the vagina, known as "turtle sign". Complications for the baby may include brachial plexus injury, or clavicle fracture. Complications for the mother may include vaginal or perineal tears, postpartum bleeding, or uterine rupture.
| Shoulder dystocia | |
|---|---|
| Suprapubic pressure being used in a shoulder dystocia | |
| Specialty | Obstetrics |
| Symptoms | Retraction of the baby's head back into the vagina |
| Complications | Baby: Brachial plexus injury, clavicle fracture Mother: Vaginal or perineal tears, postpartum bleeding |
| Risk factors | Gestational diabetes, previous history of the condition, operative vaginal delivery, obesity in the mother, an overly large baby, epidural anesthesia |
| Diagnostic method | Body fails to deliver within one minute of the head |
| Treatment | McRoberts maneuver, suprapubic pressure, Rubin maneuver, episiotomy, all fours, Zavanelli's maneuver followed by cesarean section |
| Frequency | ~ 1% of vaginal births |
Risk factors include gestational diabetes, previous history of the condition, operative vaginal delivery, obesity in the mother, an overly large baby, and epidural anesthesia. It is diagnosed when the body fails to deliver within three minutes of delivery of the baby's head. It is a type of obstructed labour.
Shoulder dystocia is an obstetric emergency. Initial efforts to release a shoulder typically include: with a woman on her back pushing the legs outward and upward, pushing on the abdomen above the pubic bone. If these are not effective, efforts to manually rotate the baby's shoulders or placing the woman on all fours may be tried. Shoulder dystocia occurs in approximately 0.4% to 1.4% of vaginal births. Death as a result of shoulder dystocia is very uncommon.