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Concept
Shoulder dystocia
Summary
Shoulder dystocia is when, after vaginal delivery of the head, the baby's anterior shoulder gets caught above the mother's pubic bone. Signs include retraction of the baby's head back into the vagina, known as "turtle sign". Complications for the baby may include brachial plexus injury, or clavicle fracture. Complications for the mother may include vaginal or perineal tears, postpartum bleeding, or uterine rupture.
Risk factors include gestational diabetes, previous history of the condition, operative vaginal delivery, obesity in the mother, an overly large baby, and epidural anesthesia. It is diagnosed when the body fails to deliver within three minutes of delivery of the baby's head. It is a type of obstructed labour.
Shoulder dystocia is an obstetric emergency. Initial efforts to release a shoulder typically include: with a woman on her back pushing the legs outward and upward, pushing on the abdomen above the pubic bone. If these are not effective, efforts to manually rotate the baby's shoulders or placing the woman on all fours may be tried. Shoulder dystocia occurs in approximately 0.4% to 1.4% of vaginal births. Death as a result of shoulder dystocia is very uncommon.
One characteristic of a minority of shoulder dystocia deliveries is the turtle sign, which involves the appearance and retraction of the baby's head (analogous to a turtle withdrawing into its shell), and a red, puffy face. This occurs when the baby's shoulder is obstructed by the maternal pelvis.
One complication of shoulder dystocia is damage to the upper brachial plexus nerves. These supply the sensory and motor components of the shoulder, arm, and hands. The ventral roots (motor pathway) are most prone to injury. The cause of injury to the baby is debated, but a probable mechanism is manual stretching of the nerves, which in itself can cause injury. Excess tension may physically tear the nerve roots out from the neonatal spinal column, resulting in total dysfunction.
Official source
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