Shoulder Dystocia





What is shoulder dystocia?

Shoulder dystocia occurs when, after delivery of the fetal head, the baby's anterior shoulder gets stuck behind the mother's pubic bone—or, occasionally, the baby’s posterior shoulder impinges on the mother’s sacrum. If this happens, the remainder of the baby does not follow the head easily out of the vagina as it usually does during vaginal deliveries.

This simple definition of shoulder dystocia, however, glosses over many complexities. For example, should a delivery be categorized as involving shoulder dystocia only when there is some time delay -- 60 seconds is often suggested in this context--between the delivery of a baby's head and shoulders? Or is shoulder dystocia present any time that a delivering clinician finds that the shoulders cannot be delivered with the normal amount of downward traction on the fetal head? Some have suggested that the definition of true shoulder dystocia requires that the birth attendant had to perform special maneuvers in order to deliver the shoulders.

Exactly how shoulder dystocia is defined is more than just a semantic issue. It sets the parameters for the collection of statistics related to shoulder dystocia, a necessity for research aimed at decreasing shoulder dystocia related injuries. It also determines when a baby's injuries might be attributed to a physician's actions during labor and delivery. For instance, if there was no true shoulder dystocia during a particular birth in which there is a brachial plexus injury, can the physician reasonably be blamed for having applied excessive traction?

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Copyright © 2017 Henry Lerner

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Shoulder Dystocia

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