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Shoulder Dystocia : Overview


Shoulder dystocia is when, after vaginal delivery of the top, the baby's anterior shoulder gets caught above the mother's pubis 
. Signs include retraction of the baby's head back to the vagina, referred to as "turtle sign". Complications for the baby may include plexus brachialis 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 within the 
mother, an excessively large baby, and epidural anesthesia .it diagnosed when the body fails to deliver within one minute of delivery of the baby's head. It’s a kind of obstructed labor.

Shoulder dystocia is an obstetric emergency. Initial efforts to release a shoulder typically include: with a lady 
on her back pushing the legs outward and upward, pushing on the abdomen above the pubis, and making a cut within the vagina. If these aren't effective, efforts to manually rotate the baby's shoulders or placing the ladies on high-low-jack could also be tried. Shoulder dystocia occurs in approximately 0.4% to 1.4% of vaginal births. Death as a results of shoulder dystocia is extremely uncommon.


Signs and symptoms

One characteristic of a minority of shoulder dystocia deliveries is that the 
turtle sign, which involves the looks and retraction of the baby's head (analogous to a turtle withdrawing into its shell), and a red, puffy face. this happens when the baby's shoulder is obstructed by the maternal pelvis.



One complication of shoulder dystocia is damage to the upper plexus brachialis 
nerves. These supply the sensory and motor components of the shoulder, arm, and hands. The ventral roots (motor pathway) are most susceptible to injury.[citation needed] The explanation for injury to the baby is debated,[citation needed] but a probable mechanism is manual stretching of the nerves, which in itself can cause injury.[citation needed] Excess tension may physically tear the nerve roots out from the neonatal vertebral column , leading to total dysfunction.[citation needed]
Possible complications include:


Neonatal complications:


Ø  Klumpke paralysis

Ø  Erb's palsy

Ø  Hypoxia

Ø  Death

Ø  Cerebral palsy


Maternal complications:


Ø  Postpartum bleeding (11%)

Ø  Pubic symphysis separation

Ø  Neuropathy of lateral femoral cutaneous nerve

Ø  Uterine rupture


Risk factors

About 16% of deliveries where shoulder dystocia occurs have conventional risk factors.[citation needed] These include diabetes, fetal macrosomia, and maternal obesity.

Risk factors:


Ø  Age >35

Ø  Short in stature

Ø  Small or abnormal pelvis

Ø  More than 42 weeks gestation

Ø  Estimated fetal weight >4,500 g

Ø  Maternal diabetes (2–4 fold increase in risk)

Factors which increase the risk/are warning signs:


Ø  Need for oxytocics

Ø  Prolonged first or second stage of labour

Ø  Turtle sign (head bobbing within the second stage)

Ø  Failure to restitute

Ø  No shoulder rotation or descent

Ø  Instrumental delivery



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