Shoulder Dystocia

What are fetal complications of shoulder dystocia?

Brachial plexus injuries due to traction during shoulder dystocia (Erb's palsy, Klumpke paralysis, cerebral palsy). Erb-Duchenne palsy is a lesion in the upper trunk (root) injury (C5-C6 with/without C7) of the brachial plexus, leading to the characteristic "waiter's tip" deformity (arm in adduction with elbow extension, forearm pronation, and wrist flexion with the fingers curled up). Clavicular fractures, long bone fractures, fetal asphyxia, anoxic brain injury, death.

How can shoulder dystocia be prevented?

Cesarean delivery indicated if fetus is >4500 g in weight in a diabetic mother or >5000 g in a non-diabetic mother.

What is manipulative management of shoulder dystocia?

Delivery of the posterior arm to allow for a rotational maneuver (e.g. Woods, Rubin I and II). Woods corkscrew maneuver: rotation of the fetal shoulders 180 degrees.

How does shoulder dystocia present clinically?

During delivery, the turtle sign may occur (retraction of the baby's head, similar to a turtle retracting into its shell) or red, puffy face.

What is shoulder dystocia?

Failure of the shoulders to spontaneously traverse the pelvis after delivery of the fetal head, due to impaction (anterior shoulder is stuck behind the mother's pubic bone). Considered an obstetric emergency.

What are other management options for shoulder dystocia?

Gaskin all-fours maneuver. Zavanelli maneuver: pushing the fetal head back into the vaginal canal with immediate transport to cesarean section.

What is non-manipulative management of shoulder dystocia?

McRoberts maneuver: hyperflexion and abduction of the mother's hips towards the abdomen without and then with suprapubic pressure. An extending episiotomy may need to be performed.

What are risk factors for shoulder dystocia?

Most commonly seen in macrosomic infants of diabetics, post-term pregnancy, multiparity, prolonged second stage of labor, forceps delivery, maternal obesity, and advanced maternal age, epidural anesthesia.

What are maternal complications of shoulder dystocia?

Perineal or vaginal tears, post-partum hemorrhage, uterine rupture.