How do I know if I have shoulder dystocia?
Your doctor can identify shoulder dystocia when they see part of your baby’s head coming out of the birth canal but the rest of their body isn’t able to delivered. Doctors call shoulder dystocia symptoms “the turtle sign.” This means a fetal head will first come out of the body but will then seem to go back into the birth canal.
What is shoulder dystocia and how is it treated?
Shoulder dystocia is an injury that can happen during childbirth. It can be overwhelming to think about the things that can go wrong during labor and delivery. But it’s important to remember these conditions are rare and your healthcare team is trained on what to do.
What are the stages of shoulder dystocia?
Shoulder dystocia is ranked from stage one to stage four in severity. All cases of shoulder dystocia may not be predictable. However, some factors increase the likelihood of shoulder dystocia occurring during vaginal delivery. These include: You have a small stature or small pelvic opening Your baby measures large on ultrasounds before birth
What are the risk factors for shoulder dystocia?
Certain conditions during labor and delivery may also be risk factors for shoulder dystocia. The most common of these risk factors is having an assisted vaginal delivery. This means your obstetrician has to use a vacuum extractor or forceps to help deliver your baby through the birth canal. Other risk factors during labor and delivery may include:
What are some signs of 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.
How is dystocia diagnosed?
Fetal dystocia is abnormal fetal size or position resulting in difficult delivery. Diagnosis is by examination, ultrasonography, or response to augmentation of labor. Treatment is with physical maneuvers to reposition the fetus, operative vaginal delivery.
Can shoulder dystocia be predicted?
CAN SHOULDER DYSTOCIA BE PREDICTED? There is expert consensus that the occurrence of shoulder dystocia cannot be accurately predicted by antenatal or intrapartum risk factors or imaging studies [2].
Which patient is at highest risk for shoulder dystocia?
Risk factors for shoulder dystocia include:Macrosomia. ... Having preexisting diabetes or gestational diabetes. ... Having shoulder dystocia in a previous pregnancy.Being pregnant twins, triples or other multiples.Being overweight or gaining too much weight during pregnancy.
What are the 3 main abnormalities that causes dystocia?
Dystocia is considered the result of any of the following during labor: (1) abnormalities of expulsive force; (2) abnormalities of presentation, position, or development of the fetus; and (3) abnormalities of the maternal bony pelvis or birth canal.
How do I get my baby out of shoulder dystocia?
The midwife or doctor will gently press on your tummy to help free the baby's shoulder. This is called the 'McRoberts manoeuvre'. Another position that can work for you to get onto all fours. Sometimes, the midwife or doctor will need to put their hand inside your vagina to free the baby's body.
How long can a baby be stuck with shoulder dystocia?
For the baby This injury may cause loss of movement (paralysis) to the baby's arm. In most cases, this is temporary and movement will return within hours or days. A small number of babies (one in 100) who have shoulder dystocia will experience permanent damage.
Can you sue for shoulder dystocia?
Yes. Mothers and babies who suffered shoulder dystocia during childbirth may have a medical malpractice claim. As such, they can file a lawsuit for damages and pain and suffering.
How can I prevent dystocia during pregnancy?
Prevention of dystocia includes encouraging the use of trained labor support companions, deferring hospital admission until the active phase of labor when possible, avoiding elective labor induction before 41 weeks' gestation, and using epidural analgesia judiciously.
At what point during a pregnancy does shoulder dystocia become evident?
Shoulder dystocia commonly occurs at stage 2, where the anterior shoulder becomes impacted on the maternal pubic symphysis.
What is the most common injury to the baby following a shoulder dystocia?
The most common complication of shoulder dystocia in your baby is brachial plexus palsy. The brachial plexus nerves run from your baby's spinal cord in their neck through their arm. These nerves are responsible for providing feeling and movement in your baby's shoulder, arm and hand.
Do you need cesarean after shoulder dystocia?
There is no definite evidence about whether or not you should have a caesarean to avoid shoulder dystocia occurring again. Your obstetrician will be able to talk through the pros and cons with you and answer any questions you have.
How Is Shoulder Dystocia Diagnosed?
Doctors diagnose shoulder dystocia when they can visualize the baby’s head but the baby’s body can’t be delivered, even after some slight maneuvers. If your doctor sees your baby’s trunk isn’t coming out easily and they have to take certain actions as a result, they’ll diagnose shoulder dystocia.
What Are the Symptoms of Shoulder Dystocia?
Doctors call shoulder dystocia symptoms “the turtle sign.” This means a fetal head will first come out of the body but will then seem to go back into the birth canal. This is said to be like a turtle that sticks its head out of its shell and puts it back in.
Can shoulder dystocia cause bleeding?
Shoulder dystocia can increase risks for both you and baby. Most mothers and babies with shoulder dystocia don’t experience any significant or long-term complications. However, it’s possible that complications, while rare, can occur. These include: excessive bleeding in the mother.
Is shoulder dystocia an emergency?
If this occurs, your doctor will have to use extra interventions to help your baby’s shoulders move through so that your baby can be delivered. Shoulder dystocia is considered an emergency. Your doctor must work quickly to prevent complications related to shoulder dy stocia.
Can you get pregnant with shoulder dystocia?
Less than 10 percent of babies with injuries after shoulder dystocia have permanent complications. If you baby has shoulder dystocia while you’re giving birth, you could be at risk for the condition if you get pregnant again. Talk to your doctor about your risks prior to delivery.
What is shoulder dystocia?
In this Article. Shoulder dystocia is a condition in which your infant’s shoulders are impacted by your pelvic bones during vaginal delivery. Depending on the severity of the impact, your infant may sustain an injury during birth, or the birth may require intervention techniques or a cesarean delivery.
Why is the posterior shoulder delivery controversial?
This technique is controversial in the medical community because it puts your baby at a greater risk of injury. Your doctor may instead conduct a posterior shoulder delivery. Your doctor attempts to deliver the front arm and shoulder first, using it to rotate your baby’s other shoulder out of your pelvic bone.
Is shoulder dystocia a problem for babies?
Even with medical advancements, shoulder dystocia is a major concern for babies and mothers. Doctors must think quickly to carefully dislodge your baby’s shoulders without causing additional damage.
Can you have a previous birth with shoulder dystocia?
However, through careful monitoring, your medical team can identify shoulder dystocia at an earlier stage before the condition worsens. If you had a previous birth affected by shoulder dystocia, your doctor may talk to you about scheduling a c-section delivery.
Can a baby's shoulders hurt?
The impact to your baby’s shoulders may cause damage to their collarbone and arms. In a worst-case scenario, it may leave your baby paralyzed. You may experience tearing or bruising around your cervix, rectum, and vagina from the force of the impact.
Can a McRoberts maneuver cause shoulder dystocia?
While it is more widely accepted, it may put your baby at risk. . Severe shoulder dystocia. The McRoberts Maneuver is standard for even more severe cases. It requires the help of two assistants who remove your legs from the stirrups and flex them back against your abdomen.
What is shoulder dystocia?
Shoulder dystocia is a complication of vaginal delivery in which the baby's shoulder gets caught above the mother's pubic bone. It is characterized by failure to deliver the fetal shoulders using solely gentle downward traction, the need for additional delivery maneuvers to deliver the baby successfully, and/or a documented head-to-body interval of greater than 1 minute. This is an obstetrical emergency requiring first-line and second-line maneuvers to deliver the baby with minimal complications. This activity reports the assessment and management of shoulder dystocia and goes over the role of the labor and delivery interprofessional team members to improve care for those with this condition.
What are the risk factors for shoulder dystocia?
Several risk factors for shoulder dystocia have been identified. Fetal macrosomia is the most significant risk factor for shoulder dystocia. Other known risk factors include pregestational and gestational diabetes, prior history of shoulder dystocia, and operative vaginal delivery, particularly with the use of the vacuum. Other risk factors such as maternal obesity , excessive maternal weight gain, and labor dysfunction are controversial since studies have had conflicting results. Attempts to predict shoulder dystocia based on these risk factors have shown poor reliability and poor predictive value. [3]
What are the most common obstetric brachial plexopathies?
Of the obstetric brachial plexopathies, upper lesions are the most common. Upper lesions result from a lateral flexion of the head away from the affected shoulder, with depression of the ipsilateral shoulder resulting in a C5-6 deficiency. Lower lesions are caused by traction with the shoulder in full abduction at the time of delivery. Total brachial plexopathies are the rarest form of obstetric plexopathies and are caused by a severe stretch or avulsion type injury. [4]
What are the consequences of shoulder dystocia?
There are potential maternal and fetal consequences following shoulder dystocia. Maternal consequences include postpartum hemorrhage and an increased risk of third or fourth-degree lacerations. Certain "heroic maneuvers" such as the Zavanelli maneuver is associated with significant maternal morbidity. Fetal consequences include fetal brachial plexus injuries, fetal clavicular or humeral fracture, hypoxic ischemic encephalopathy syndrome, and even fetal death. Most brachial plexus injuries are transient and resolve with time and physical therapy. Fetal fractures typically heal without consequences. [5][6][7]
How to treat brachial plexopathy?
Any suspected brachial plexopathy should undergo a trial of observation and daily passive exercises to await the return of function. The most important consideration in early non-operative management is maintaining the passive motion of the extremity while awaiting nerve function return.
How to deliver the posterior arm?
Delivery of the posterior arm: the obstetrician slides a hand along the fetal posterior shoulder and arm, and the fetal forearm or wrist is grasped and swept across the anterior fetal chest to effect delivery of the posterior arm. If the fetal forearm is not easily accessible, one can follow the posterior fetal arm and put pressure on the antecubital fossa, and this will typically lead to flexion of the fetal arm, allowing access to the fetal forearm. With the successful delivery of the posterior arm, the axillo-acromial diameter becomes the presenting part, and it is typically about 3 centimeters shorter and leads to delivery of the anterior shoulder.
How to prevent glenohumeral dysplasia?
To prevent glenohumeral dysplasia from persistent internal rotation of the humerus, tendon transfers or tendon lengthening procedures may be considered. The Hoffer procedure is a transfer of the latissimus dorsi and teres major to external rotators of the humerus. Pectoralis major and subscapularis tendon lengthening procedures can serve to lessen the internal rotation forces that remain unopposed in upper lesions. Alternatively, practitioners may consider a Wickstrom osteotomy, which serves as a proximal humeral derotation osteotomy to combat the internal rotation contracture present in such plexopathies. [11][12]
What is shoulder dystocia?
Shoulder dystocia, a complication of vaginal delivery in which the fetal shoulders fail to deliver spontaneously after the head emerges, is uncommon but potentially treacherous. Its precise incidence is difficult to ascertain, owing to the different definitions used in the literature and uncertainty about how often its occurrence is documented in medical records. Estimates range between 0.15 and 2.0% [1–3]. Although most cases of shoulder dystocia can be relieved without permanent sequelae for the neonate, this is not always the case [4,5]. Complications include various degrees of brachial plexus injury (BPI) and, less commonly, asphyxial or traumatic central nervous system damage and long bone fractures [6]. Maternal adversity in the form of lacerations, hemorrhage and psychological stress occurs as well [7]. BPI occurs in about 1–20% of shoulder dystocia cases [1–2,6,8]. It is often a transient neuropraxis and recovers fully in hours to months; it is permanent in about 3–10% of cases [6,9], probably the result of avulsion of nerve tissue. The likelihood of intact survival after shoulder dystocia depends heavily on the skill with which it is managed; preemptive cesarean delivery of babies at high risk would be ideal, but the identification of such cases can be challenging.
What is the importance of a protocol in a shoulder delivery?
The presence of a protocol, unique to each institution, is vital. Once triggered by personnel at the delivery a series of events should be set in motion so that help is summoned. An experienced obstetrician and obstetrical nurse are important, as may be a neonatologist and anesthesiologist. If the patient was deemed to be at very high risk extra help should be immediately available in anticipation of difficult shoulder delivery.
How long does it take for a shoulder to recover from BPI?
BPI occurs in about 1–20% of shoulder dystocia cases [1–2,6,8]. It is often a transient neuropraxis and recovers fully in hours to months; it is permanent in about 3–10% of cases [6,9], probably the result of avulsion of nerve tissue.
Is shoulder dystocia a maternal or fetal complication?
There are a number of matern al and fet al characteristics associated with the development of shoulder dystocia and BPI, but many cases develop without recognized antecedent risk factors [16]. The ability to predict the occurrence in an individual delivery is limited, but not unachievable (see below), and the prevailing notion that shoulder dystocia is always an unexpected complication has done little to advance our understanding of how it might be prevented [17,18]. Several algorithms have been suggested to predict and thereby prevent shoulder dystocia based on identifiable predisposing factors [19–23]. Risk factors for shoulder dystocia and BPI can be usefully categorized into those identifiable in the patient's history, and those that arise or are identified during prenatal care or labor (Box 1).
Can BPI cause shoulder dystocia?
Moreover, it seems equally clear that BPI can occur in association with shoulder dystocia even when the complication has been managed optimally. The weight of the available information suggests, however, that inopportune medical intervention is probably a factor in most injuries.
Can shoulder dystocia be relieved?
Although most cases of shoulder dystocia can be relieved without permanent sequelae for the neonate, this is not always the case [4,5]. Complications include various degrees of brachial plexus injury (BPI) and, less commonly, asphyxial or traumatic central nervous system damage and long bone fractures [6].
When the lead provider is attempting to rotate the shoulders, it is advantageous for an assistant to facilitate rotation?
When the lead provider is attempting to rotate the shoulders it is advantageous for an assistant to facilitate rotation by applying pressure to the anterior shoulder suprapubically. This pressure should be directed posterolaterally in the same direction as vaginal attempts by the lead provider so as to encourage rotation of the trunk. Suprapubic pressure directed posteriorly will not accomplish that goal.
What is shoulder dystocia?
An objective definition of shoulder dystocia: prolonged head-to-body delivery intervals and/or the use of ancillary obstetric maneuvers. Obstet Gynecol 1995; 86:433.
What is the goal of management of shoulder dystocia?
The goal of management is to prevent fetal asphyxia and permanent Erb's palsy or death, while avoiding physical injury (eg, fetal fracture, maternal tissue trauma), but the latter is acceptable if needed to prevent permanent injury in the child. Intrapartum diagnosis and management of shoulder dystocia will be reviewed here.
What happens if the fetal shoulder is in an anterior position?
If the fetal shoulders remain in an anterior-posterior position during descent or descend simultaneously rather than sequentially into the pelvic inlet, then the anterior shoulder can become impacted behind the symphysis pubis or descent of the posterior shoulder may be obstructed by the sacral promontory.
Is anterior or posterior shoulder obstructed?
Anterior obstruction is more common than posterior obstruction. If descent of the fetal head continues while descent of the anterior or posterior shoulder remains obstructed, then the nerves in the brachial plexus may stretch, which may result in nerve injury.
Can shoulder dystocia be prevented?
Few shoulder dystocias can be anticipated and prevented, as most occur in the absence of risk factors. Therefore, the obstetric provider must be prepared to recognize a shoulder dystocia immediately and proceed through an orderly sequence of steps to accomplish delivery in a timely manner.