Shoulder dystocia is a specific case of dystocia whereby after the delivery of the head, the anterior shoulder of the infant cannot pass below the pubic symphysis, or requires significant manipulation to pass below the pubic symphysis. It is diagnosed when the shoulders fail to deliver shortly after the fetal head. In shoulder dystocia, it is the chin that presses against the walls of the perineum[1]
Treatment
A number of obstetrical maneuvers are sequentially performed in attempt to facilitate delivery at this point, including :
- Gaskin maneuver, named after Certified Professional Midwife, Ina May Gaskin, involves moving the mother to an all fours position with the back arched, widening the pelvic outlet.
- suprapubic pressure (or Rubin I)[4]
- Rubin II or posterior pressure on the anterior shoulder, which would bring the fetus in an oblique position with head somewhat towards the vagina[5]
- Woods' screw maneuver which leads to turning the anterior shoulder to the posterior and vice versa (somewhat the opposite of Rubin II maneuver)[6]
More drastic maneuvers include
- intentional clavicular fracture, which reduces the diameter of the shoulder girdle that requires to pass through the birth canal.
- symphisiotomy, which makes the opening of the birth canal laxer by breaking the connective tissue between the two pubes bones facilitating the passage of the shoulders.
- abdominal rescue, described by O'Shaughnessy, where a hysterotomy facilitates vaginal delivery of the impacted shoulder[8]
Risk factors
Although the definition is imprecise, it occurs in approximately 1% of vaginal births. There are well-recognised risk factors, such as diabetes,[9] fetal macrosomia, and maternal obesity, but it is often difficult to predict[10]. Despite appropriate obstetric management, fetal injury (such as brachial plexus injury) or even fetal death can be a complication of this obstetric emergency.
Recurrence rates are relatively high and low most of the short time.[11]
References
- ^ Kish, Karen; Joseph V. Collea (2003). "Malpresentation & Cord Prolapse (Chapter 21)", in Alan H. DeCherney: Current Obstetric & Gynecologic Diagnosis & Treatment, Lauren Nathan, Ninth Edition, Lange/McGraw-Hill, 381-382. ISBN 0-07-118207-1.
- ^ Stallard TC, Burns B (2003). "Emergency delivery and perimortem C-section". Emerg. Med. Clin. North Am. 21 (3): 679–93. doi:10.1016/S0733-8627(03)00042-7. PMID 12962353.
- ^ Kish, Karen; Joseph V. Collea (2003). "Malpresentation & Cord Prolaps (Chapter 21)", in Alan H. DeCherney: Current Obstetric & Gynecologic Diagnosis & Treatment, Lauren Nathan, Ninth Edition, Lange/McGraw-Hill, 382. ISBN 0-07-118207-1.
- ^ "Shoulder Dystocia Management". Retrieved on 2007-11-28.
- ^ "Shoulder Dystocia - April 1, 2004 - American Family Physician". Retrieved on 2007-11-28.
- ^ "Fetal Dystocia: Abnormalities and Complications of Labor and Delivery: Merck Manual Professional". Retrieved on 2007-11-28.
- ^ Fernandez H, Papiernik E (1990). "[The Zavanelli maneuver: use during breech retention of the head in the birth canal. Apropos of a case]" (in French). J Gynecol Obstet Biol Reprod (Paris) 19 (4): 483–5. PMID 2380511.
- ^ O'Shaughnessy MJ (1998). "Hysterotomy facilitation of the vaginal delivery of the posterior arm in a case of severe shoulder dystocia". Obstet Gynecol 92 (4 Pt 2): 693–5. doi:10.1016/S0029-7844(98)00153-7. PMID 9764668.
- ^ Jouatte F, Aitken B, Dufour P, et al (1999). "[Diabetes before pregnancy, apropos of 143 cases]" (in French). Contracept Fertil Sex 27 (12): 845–52. PMID 10676041.
- ^ Breeze AC, Lees CC (2004). Managing shoulder dystocia. Lancet 364, 2160-1[1]
- ^ Gurewitsch ED, Johnson TL, Allen RH (2007). "After shoulder dystocia: managing the subsequent pregnancy and delivery". Semin. Perinatol. 31 (3): 185–95. doi:10.1053/j.semperi.2007.03.009. PMID 17531900.
See also
External links
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