What is Shoulder Dystocia?
Shoulder dystocia occurs when the baby's head is delivered but the shoulders become stuck behind the mother's pubic bone. It's an obstetric emergency requiring immediate intervention, occurring in approximately 1-2% of deliveries.
Risk Factors
Doctors should anticipate and prepare for shoulder dystocia when risk factors are present:
- ✓Maternal diabetes or gestational diabetes
- ✓Estimated fetal weight over 4,000-4,500 grams
- ✓Maternal obesity
- ✓Previous shoulder dystocia delivery
- ✓Post-term pregnancy
- ✓Prolonged second stage of labor
Proper Management Techniques
When shoulder dystocia occurs, trained providers should use established maneuvers in a specific order:
- ✓McRoberts maneuver: Hyperflexing the mother's legs
- ✓Suprapubic pressure: Applying pressure above the pubic bone
- ✓Internal maneuvers: Rotating the baby's shoulders
- ✓Delivery of posterior arm
- ✓All-fours position (Gaskin maneuver)
Injuries from Shoulder Dystocia
Improper management or excessive force can cause brachial plexus injuries, fractured clavicle, fractured humerus, and oxygen deprivation leading to brain damage if the baby is stuck too long. The mother can also suffer uterine rupture or severe hemorrhaging.
When Negligence Occurs
Medical negligence in shoulder dystocia cases includes: failing to anticipate dystocia despite risk factors, applying excessive traction to the baby's head, not following proper maneuver protocols, and taking too long to deliver the baby causing oxygen deprivation.