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Shoulder dystocia is an obstetric urgency which requires a fast and effective handling. Resulting brachial plexus lesions, hypoxic states and deceases derived from a shoulder dystocia are often the subject of forensic medicine disputes contexting the Obstetric who doesn't perform the caesarean section.Brachial plexus lesions mechanism is directly correlated with untimely and excessive tractions performed to resolve a shoulder dystocia.These tractions lower the thorax towards the pelvis and thus the thoracic cone while descending, it increases the bisacromial diameter. Neonatal morbidity is represented by Erb's palsy, phrenic nerve palsy and as a consequence diaphragm palsy, and finally by fractures of the clavicle.Recent medical literature describes shoulder dystocia rate which is between 0.5% and 1.5% of deliveries.
Risk Factors
Shoulder dystocia most important risk factor is fetal macrosomia. Diabetes is an important twofold risk factor. Here are further risk factors: operative vaginal delivery; previous shoulder dystocia; advanced maternal age.
Shoulder dystocia treatment
A known protocol of all the maneuvers has to be available in the delivery room; The presence of an expert Obstetric, an Anesthetist and a Pediatrician during the delivery of women with shoulder dystocia's risk factors is required; Position the patient in dorsal decubitus with her pelvis over bed border; Perform a wide prophylactic mediolateral episiotomy; Position an assistant on each side of the patient that are going to hyper flex her thigh on her abdomen (Mc Roberts maneuver). Internal maneuvers have to be performed if a failure occurs. Woods is one of the first maneuvers to be performed. Rubin maneuver consists of the opposite kind of movement. One of the most classic maneuvers is the Jacquemier maneuver: it's based on the extraction of the posterior arm. If all these maneuvers fail only two alternative possibilities remain: Zarate maneuver and Zavanelli maneuver.
shoulder dystocia