Precipitate delivery position12/27/2023 ![]() Maternal prepregnancy obesity and the risk of shoulder dystocia: a meta-analysis. Critical analysis of risk factors for shoulder dystocia. Objective definition of shoulder dystocia: a prospective evaluation. American College of Obstetricians and Gynecologists 2014.īeall MH, Spong C, McKay J, et al. 2006 195(3):657-672.Īmerican College of Obstetricians and Gynecologists Task Force on Neonatal Brachial Plexus Palsy. Shoulder dystocia: the unpreventable obstetric emergency with empiric management guidelines. ![]() Gherman RB, Chauhan S, Ouzounian JG, et al. Brachial plexus palsy involving the posterior shoulder at spontaneous vaginal delivery. ACOG also recommends consideration of cesarean delivery for a patient who has diabetes and is carrying a fetus with an estimated fetal weight of 4,500 g (9 lb, 15 oz). 13 Given the increased risk of shoulder dystocia with increasing fetal weights, the American College of Obstetricians and Gynecologists (ACOG) recommends consideration of cesarean delivery for a patient who does not have diabetes and is carrying a fetus with an estimated fetal weight of 5,000 g (11 lb). 12 Results from studies evaluating labor induction for suspected macrosomia are inconsistent, and induction is not recommended to prevent shoulder dystocia. 11 Although the incidence of shoulder dystocia increases with increasing fetal weight and maternal diabetes, one study of pregnancies complicated by shoulder dystocia found that half of the neonates weighed less than 4,000 g (8 lb, 13 oz) and that only 20% of the patients had diabetes. At term, fetal sonography has at least a 10% margin of error for diagnosis of macrosomia. Each institution should consider the length of time it will take to prepare the operating room for general inhalational anesthesia and abdominal rescue and practice this during simulation exercises.įetal macrosomia is difficult to accurately predict. When these are unsuccessful, additional maneuvers, including intentional clavicular fracture or cephalic replacement, may lead to delivery. Calm and thoughtful use of release maneuvers such as knee to chest (McRoberts maneuver), suprapubic pressure, posterior arm or shoulder delivery, and internal rotational maneuvers will almost always result in successful delivery. Unequivocally announcing that dystocia is happening, summoning extra assistance, keeping track of the time from delivery of the head to full delivery of the neonate, and communicating with the patient and health care team are helpful. Training and simulation exercises improve physician and team performance when shoulder dystocia occurs. Labor and delivery teams should always be prepared to recognize and treat this emergency. Although fetal macrosomia, prior shoulder dystocia, and preexisting or gestational diabetes mellitus increases the risk of shoulder dystocia, most cases occur without warning. This can cause neonatal brachial plexus injuries, hypoxia, and maternal trauma, including damage to the bladder, anal sphincter, and rectum, and postpartum hemorrhage. While this is generally a safe procedure, there are some possible complications.Shoulder dystocia is an obstetric emergency in which normal traction on the fetal head does not lead to delivery of the shoulders. Blood transfusion: Following excessive bleeding, you might require a blood transfusion.Your obstetrician will recognize this and take steps to remove the placenta, sometimes this requires a minor procedure. This can lead to a severe infection or life-threatening complications if not managed. Following rapid labor, the placenta may not deliver spontaneously. Retained placenta: During the third stage of labor, you should expel the placenta completely within 30 minutes.This condition is usually treatable, but it can lead to shock or, in rare cases, death. ![]()
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