incidence of shoulder dystocia among vaginal deliveries e Practice Bulletin Shoulder Dystocia .. these resources at –Info/Shoulder. Along with the American College of Obstetricians and Gynecologists (ACOG) practice bulletin on shoulder dystocia, guidelines from England, Canada, Australia. Request PDF on ResearchGate | On Feb 1, , Robert J Sokol and others published ACOG practice bulletin: Shoulder dystocia. Number 40, November

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Practice Bulletin No 178: Shoulder Dystocia.

As the most recent ACOG bulletin on shoulder dystocia states, “Most cases of shoulder dystocia cannot be accurately predicted or prevented. The reason for the increased risk of shoulder dystocia in these babies has to do with their different growth morphology compared with babies of nondiabetic mothers.

Other injuries sometimes seen are:. Risk factors for shoulder dystocia While many factors ;ractice been cited as increasing the risk for shoulder dystocia, careful analysis shows that there are only four primary risk factors: If any of these nerves are permanently injured, paralysis develops in the muscles innervated by the affected nerve.

Shoulder Dystocia – Cancer Therapy Advisor

When the entire chain of brachial plexus nerves are injured—a pan-brachial plexus injury C5-T1 —all of the muscles of the arm are affected. And to the surgical risks must be added: Deliveries requiring mid vacuum prwctice forceps result in rates of shoulder dystocia that are 4. It outlines much evidence against this oft-claimed but unproven hypothesis. It is often preceded by the turtle sign.

No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. Briefly explain to the patient that the baby’s shoulders are “temporarily stuck” and that you and your team will be working to get the baby out safely.


Direct crushing pressure of the brachial plexus nerves against the maternal pubic bone caused by the endogenous forces of uterine contractions and maternal expulsive efforts. Make the management of this emergency as deliberate and efficient as possible. Annals of Neurology ;8: Mathematic modeling of forces associated with shoulder dystocia: These maneuvers are variations of ways of rotating the fetal shoulders in order to change their orientation in the maternal pelvis.

Klumpke’s palsy involves damage of the C-8 and T-1 nerve roots. The McRoberts maneuver is almost always used in conjunction with suprapubic pressure. This Practice Bulletin does a good job of summarizing issues of the predictability of shoulder dystocia and of physician management of it; the bulletin does not go into specific maneuvers or protocols. While many factors have been cited as increasing the risk for shoulder dystocia, careful analysis shows that there are only four primary risk factors:.

Lerner Jump to Section Shoulder dystocia 1. Rouse and Owen showed that the policy of prophylactic cesarean delivery for suspected macrosomia would require several thousand cesarean deliveries and millions of dollars to avert a single permanent brachial plexus injury.

Suggested clinical approach to “risk factors” Patients who have true risk factors for shoulder dystocia—suspected macrosomia, gestational diabetes, a history of a previous shoulder dystocia— must be counseled about their increased risk for shoulder dystocia, and this conversation must be documented in the medical record. Begin the series of shoulder dystocia resolution maneuvers in a calm, deliberate, yet time-sensitive fashion.

Fundal pressure serves only to drive the impacted shoulder further into a nondeliverable position, and should never bullwtin employed in the context of a shoulder dystocia. Cancer Therapy Advisor Daily Update. Umbilical cord transection may prevent even minimal blood flow to the baby throughout the duration of the dystocia.


In babies of diabetic mothers, the risk of shoulder dystocia in any weight group is 2.

ACOG Practice Bulletin # Shoulder Dystocia

The McRoberts maneuver Figure 2 is the most commonly used shoulder dystocia resolution maneuver. While other maneuvers to resolve shoulder dystocia are described, they are rarely employed, either because of their high rate of complications or praftice difficulty of performing them Table IV. This results in Horner’s syndrome: Other maneuvers to resolve shoulder dystocia 5. Complications Neonatal injury What causes brachial plexus injuries?

Not only is this a tremendous tragedy for each child and family involved, but a very large percentage of these cases wind up in litigation. Most women who experience shoulder dystocia have no combination of risk factors that allows clinically useful prediction prior to delivery. Thus, if shoulder dystocias occur in roughly one in vaginal deliveries, the rate of permanent brachial plexus injury is one in 10, vaginal deliveries.

Shoulder dystocia occurs when there is an inability to deliver a baby’s shoulders after its head has emerged.

Women’s Health Care Physicians

Approximately half of all shoulder dystocias occur with newborns weighing less than 4, g, below anybody’s definition of macrosomia. Measure cord blood gases Being able to document whether there was in fact real asphyxia at birth and whether there was a base deficit—indicative of longer-term asphyxia—can provide important information both as to the baby’s status and as a refutation dystoia later claims of inappropriate care.

This prevents the normal sequence of prompt delivery of the practie following that of the head.