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Shoulder Dystocia: Causes, Risk Factors, Complications , Management

What is Shoulder Dystocia?

Shoulder dystocia is a condition that can occur during childbirth and is potentially dangerous. In it, the infant’s head emerges but the shoulder remains trapped in the pubic bone of the female.

If the baby’s head is born for longer than a minute and the shoulders do not emerge, doctors consider it shoulder dystocia. It is a medical emergency and can cause serious complications for both mother and the child. It can lead to serious injuries. Sometimes, this condition can be managed easily with a change of position. In severe cases, more significant interventions may be needed such as breaking the infant’s collarbone or performing an immediate cesarean.

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It is an uncommon condition and occurs in 0.5% to 1% of females.(1)

Causes and Risk Factors of Shoulder Dystocia

The risk of shoulder dystocia increases if the baby’s weight is more than 4.5 kg. Other risk factors include:

  • Gestational diabetes
  • Use of epidural anesthesia
  • Prolonged second stage
  • Obesity in the birthing parent
  • Pelvic stenosis
  • Giving birth to a male baby
  • Vacuum or forceps-assisted delivery
  • Gestation longer than 42 weeks
  • Significant weight gain during pregnancy

Complications of Shoulder Dystocia

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If the delivery is quick the infants with shoulder dystocia are born without any injury. If the delay is longer the chances of complications increase.

Brachial plexus injury is the most common complication of shoulder dystocia and is known to affect 3-17 % of babies.(2) It can lead to damage to the shoulder and neck. Infants with this complication may suffer from reduced movement or difficulties in moving their arms and hands. Most of them recover in a few months while a few may need surgery.

Other complications of shoulder dystocia include:

  • Humerus Fracture: This is known to affect 1% to 4.3 % of infants with shoulder dystocia.
  • Clavicle Fracture: This is known to affect 1-9.5% of infants with shoulder dystocia.
  • Hypoxic Brain Injury: It is a rare complication and affects 0.3% of infants with shoulder dystocia.
  • Death: 0.35% of infants are affected by it.
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A study done in 2017, followed healthcare professionals who implemented special protocols for shoulder dystocia. These protocols showed that infants with shoulder dystocia if delivered in less than 3 minutes will have less risk of complications.(3)

Management of Shoulder Dystocia

Various techniques can be adopted for the safe delivery of infants with shoulder dystocia.

These techniques include:(2)

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  • McRobert Maneuver: This is a first-line intervention that involves bending the knees and flexing the thighs back towards the abdomen of the birthing female. This increases the space in the birthing canal.
  • Suprapubic Pressure: This involves applying downward pressure on the pubic area along with the position changes.
  • Gaskin Maneuver: If the McRoberts maneuver fails Gaskin maneuver can be used. It involves placing the individual on their hands and knees. Then the healthcare professional inserts a hand into the vagina and applies downward pressure on the infant’s shoulder.
  • Moving the Baby: There are several interventions involving moving the baby for delivery. The female is asked to come to a position that widens the birthing canal and the doctor by inserting his hand into the vagina tries to deliver at least one shoulder, making it easier for the infant to pass through.

If the above interventions are ineffective the doctor tries other significant measures. These may cause injuries to both the mother and the baby, but may be necessary.

This intervention includes:

  • Clavicular Fracture: Sometimes the doctor intentionally fractures the baby’s collarbone to make it easier to move out.
  • Zavanelli Maneuver: In this, the baby’s back is rotated to make an emergency cesarean delivery.
  • Abdominal Rescue: This intervention involves making a surgical incision in the pelvis, so that the baby can be rotated, freeing them and making vaginal delivery possible.
  • Symphysiotomy: It involves widening the delivery space by making a cut in the pubic cartilage. It can cause many complications for the baby and the mother but may be the best option for them.

Shoulder dystocia is a medical emergency that needs immediate care. Position changes and encouraging pushing can be helpful in avoiding complications. Also, those with shoulder dystocia have a significant risk of another shoulder dystocia. It is therefore important to discuss the history with a doctor and develop a precautionary treatment plan.

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