incidence of shoulder dystocia among vaginal deliveries e Practice Bulletin Shoulder Dystocia .. these resources at –Info/Shoulder. Along with the American College of Obstetricians and Gynecologists (ACOG) practice bulletin on shoulder dystocia, guidelines from England, Canada, Australia. Request PDF on ResearchGate | On Feb 1, , Robert J Sokol and others published ACOG practice bulletin: Shoulder dystocia. Number 40, November

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Women’s Health Care Physicians

Shoulder dystocia results from a misfit between the fetal shoulder and the boney pelvis; it is not a soft-tissue dystocia. Cancer Therapy Advisor Daily Update. While it is universally acknowledged that inappropriate traction on a baby’s head during an attempt to resolve a shoulder dystocia can cause a brachial plexus injury, the consensus view – as expressed in the ACOG Practice Bulletin on shoulder dystocia and in the major obstetrical textbooks – is that there are multiple potential etiologies for brachial plexus injury see Figure 5: This has been demonstrated repeatedly in innumerable studies over multiple decades.

Diagnosis and differential diagnosis Definition of shoulder dystocia Shoulder dystocia occurs when there is an inability to deliver a baby’s shoulders after its head has emerged.

The clinician must promptly recognize this as a shoulder dystocia and immediately do the following: Induction of labor versus expectant management in macrosomia: Fundal pressure serves only to drive the impacted shoulder further into a nondeliverable position, and should never be employed in the context of a shoulder dystocia. Stretching of the brachial nerves by endogenous forces—maternal pushing and uterine contractions. In fact, the article does no such thing.

An in utero injury? In the Wood’s corkscrew maneuver Figure 4the anterior surface of either uppr or lower fetal shoulder is pushed by the deliverer’s hand in an effort to “torque” the baby out of the vagina. The hand or arm is then swept across the fetal chest and delivered. Some studies have shown that clinical estimates of fetal weight by palpation are more accurate than are ultrasound estimates. The only props needed are a pelvic model and a doll.

Deliveries requiring mid vacuum or forceps result in rates of shoulder dystocia that are 4.

Shoulder Dystocia

It is vital, therefore, for the delivering clinician to make time to sit and talk to the family and friends after the delivery and to explain what really transpired and why. Keep your shoulder dystocia knowledge and skills sharp with simulation drills, on-line and in-person refresher courses, and memory tools, such as checklists and documentation forms.


Gonik’s mathematical “proof” that endogenous forces—uterine contractions and maternal pushing—can be 4 to 9 times greater than exogenous forces—physician traction—added additional support to those formulating alternative hypotheses regarding the causation of brachial plexus injuries. A comparison of endogenous and exogenous forces”.

This incidence has risen over the last decade, largely due to the almost epidemic national increase in maternal obesity, a major risk factor for fetal macrosomia. Have a discussion with the family about the events that transpired—and document this conversation Family and friends observing the delivery see a relatively calm labor room erupt into a frenzy of activity with voices becoming tense and multiple medical practitioners coming and going.

The McRoberts maneuver Figure 2 is the most commonly used shoulder dystocia resolution maneuver. AM J Obstet Gynecol. Most other proposed risk factors for shoulder dystocia exert their influence because of their association with increased birth weight. Prevention Although shoulder dystocia is, in most cases, unpredictable and unpreventable, there are certain precautions that can be taken which will enable you to be best prepared when it does occur: Obstetricians and society will have to make a decision as to the number of unnecessary cesarean sections it is willing to have performed in order to prevent a single case of permanent brachial plexus injury.

Mathematic modeling of forces associated with shoulder dystocia: Suprapubic pressure Figure 3 is pressure applied just above the maternal symphysis pubis to the anterior shoulder of the fetus.

Lerner Jump to Section Shoulder dystocia 1. The Rubin’s approach has the added benefit of “flexing” the shoulders, bringing them closer together and thus decreasing the biacromial diameter.

When the entire chain bullletin brachial plexus nerves are injured—a pan-brachial plexus injury C5-T1 dysyocia of the muscles of the arm are affected. This leads to a clawlike, paralyzed hand with—if it is in isolation—good elbow and shoulder function.

It is still a key source for data on the percentage of shoulder dystocia deliveries in 1 various neonatal weight groups and 2 between babies born of diabetic and nondiabetic mothers.

Cancer Therapy Advisor Weekly Highlights.

This theoretical framework squares with the many reports of brachial plexus injuries from cesarean section deliveries, when there was no shoulder dystocia, and with the observation of the dystociaa sign. The exact duration of shoulder dystocia necessary to cause central neurologic damage is uncertain but is thought to be between 6 and 10 minutes. If any of these nerves are permanently injured, paralysis develops in the muscles innervated by the affected nerve.


You documented this discussion. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The clinician must promptly recognize this as a shoulder dystocia and immediately do the following:.

A nerve that is partially torn can often regenerate itself with restoration of function; ruptured or avulsed nerves do not regenerate and cannot be repaired. This is one of the first articles looking critically at the claim that all brachial plexus injury is caused by “excessive” physician traction.

Avoid an inappropriate sense of urgency while at the same time recognizing that you have somewhere between 6 to shouldsr minutes before central neurologic damage is likely to occur. Again, pracrice majority of those who have studied shoulder dystocia would answer “No.

Counsel such patients as to their risk of having a shoulder dystocia at delivery, and let them know their options and the pros and cons of these options.

Practice Bulletin No Shoulder Dystocia.

Nevertheless, if you are sued for a brachial plexus injury, this is the article the plaintiff attorney will use to try to demonstrate the unfounded conclusions that: Moreover, many other textbooks and papers discuss 4, g and 4, g, respectively, as weights at which to “consider” recommending a cesarean section. Stretching of the brachial plexus nerves by inappropriate physician traction Damage to the brachial bulletinn nerves despite appropriate traction and delivery maneuvers due to the intrinsic variation in the strength of nerve dyystocia between shouldwr neonates i.

Even for higher risk patients whose mothers have gestational diabetes and suspected macrosomia, unnecessary cesarean sections would have to be performed to prevent one permanent brachial plexus injury. Umbilical cord transection may prevent even minimal blood flow to the baby throughout the duration of the dystocia. Have a discussion with the family about the events that transpired—and document this conversation. Prognosis and outcome Controversies regarding shoulder dystocia Is shoulder dystocia predictable?

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