CC BY 4.0 · Rev Bras Ginecol Obstet 2022; 44(07): 723-736
DOI: 10.1055/s-0042-1755446
Febrasgo Position Statement

Management of shoulder dystocia

Number 7 – July 2022
1   Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
,
2   Hospital Maternidade Interlagos, São Paulo, SP, Brazil
,
3   Faculdade de Medicina, Universidade Federal de São Carlos, São Carlos, SP, Brazil
,
4   Faculdade de Medicina, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
› Author Affiliations

Key points

  • Shoulder dystocia is a predominantly unpredictable and non-preventable event.

  • The progressive incidence of obesity and diabetes has determined the contemporary increase in shoulder dystocia incidence.

  • The main risk factors for shoulder dystocia are fetal macrosomia, diabetes mellitus, dystocia in the functional periods of labor and operative vaginal delivery.

  • Clinical imaging and pelvimetry are not helpful in identifying women at higher risk for shoulder dystocia.

  • Diagnosis and severity of shoulder dystocia are subjective. Failure of the head-shoulder maneuver and the turtle sign are the main diagnostic criteria. The need for multiple delivery maneuvers and the occurrence of maternal and/or neonatal injuries better evidence the severity of cases.

  • Professionals involved in childbirth care must be prepared to recognize shoulder dystocia and immediately perform a sequence of maneuvers for its correction in a timely manner.

  • Control of body weight and blood glucose levels is the main strategy likely to reduce the risk of shoulder dystocia.

  • The most common serious maternal complications of shoulder dystocia are postpartum hemorrhage and complicated perineal lacerations.

  • The most frequent neonatal complication of shoulder dystocia is transient brachial plexus palsy.

  • Skills training and simulation improve the care and documentation of shoulder dystocia, promoting evidence-based management and reducing transient brachial plexus injuries.

The National Specialty Commission in Obstetric Emergencies of the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO) endorses to this document. The content production is based on scientific studies on a thematic proposal and the findings presented contribute to clinical practice.




Publication History

Article published online:
08 August 2022

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