Shoulder dystocia: The unpreventable obstetric emergency with empiric management guidelines

Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, United States
American journal of obstetrics and gynecology (Impact Factor: 4.7). 10/2006; 195(3):657-72. DOI: 10.1016/j.ajog.2005.09.007
Source: PubMed


Much of our understanding and knowledge of shoulder dystocia has been blurred by inconsistent and scientific studies that are of limited scientific quality. In an evidence-based format, we sought to answer the following questions: (1) Is shoulder dystocia predictable? (2) Can shoulder dystocia be prevented? (3) When shoulder dystocia does occur, what maneuvers should be performed? and (4) What are the sequelae of shoulder dystocia?
Electronic databases, including PUBMED and the Cochrane Database, were searched using the key word "shoulder dystocia." We also performed a manual review of articles included in the bibliographies of these selected articles to further define articles for review. Only those articles published in the English language were eligible for inclusion.
There is a significantly increased risk of shoulder dystocia as birth weight linearly increases. From a prospective point of view, however, prepregnancy and antepartum risk factors have exceedingly poor predictive value for the prediction of shoulder dystocia. Late pregnancy ultrasound likewise displays low sensitivity, decreasing accuracy with increasing birth weight, and an overall tendency to overestimate the birth weight. Induction of labor for suspected fetal macrosomia has not been shown to alter the incidence of shoulder dystocia among nondiabetic patients. The concept of prophylactic cesarean delivery as a means to prevent shoulder dystocia and therefore avoid brachial plexus injury has not been supported by either clinical or theoretic data. Although many maneuvers have been described for the successful alleviation of shoulder dystocia, there have been no randomized controlled trials or laboratory experiments that have directly compared these techniques. Despite the introduction of ancillary obstetric maneuvers, such as McRoberts maneuver and a generalized trend towards the avoidance of fundal pressure, it has been shown that the rate of shoulder-dystocia associated brachial plexus palsy has not decreased. The simple occurrence of a shoulder dystocia event before any iatrogenic intervention may be associated with brachial plexus injury.
For many years, long-standing opinions based solely on empiric reasoning have dictated our understanding of the detailed aspects of shoulder dystocia prevention and management. Despite its infrequent occurrence, all healthcare providers attending pregnancies must be prepared to handle vaginal deliveries complicated by shoulder dystocia.

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    • "performance of a series of manoeuvres: some of them are technically challenging even under normal circumstances. Th erefore, all healthcare providers attending pregnancies should be prepared to handle vaginal deliveries complicated by this infrequent and unpredictable condition (Gherman et al. 2006). Shoulder dystocia ' drills ' have been suggested by many authors not only to coordinate a teamwork approach, but also to provide an opportunity to practice and improve the performance of various manoeuvres (Deering et al. 2004; Gherman 2005; Buerkle et al. 2012; Grobman 2013). "
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    ABSTRACT: Condensation: In our questionnaire, a video tutorial illustrating the management of shoulder dystocia was considered by health personnel as a useful complementary training tool. We prepared a 5-min video tutorial on the management of shoulder dystocia, using a simulator that includes maternal pelvic and baby models. We performed a survey among obstetric personnel in order to assess their opinion on the tutorial by inviting them to watch the video tutorial and answer an online questionnaire. Five multiple-choice questions were set, focusing on the video's main objectives: clarity, simplicity and usefulness. Following the collection of answers, global and category-weighted analyses were conducted for each question. Out of 956 invitations sent, 482 (50.4%) answered the survey. More than 90% of all categories found the video tutorial to be clinically relevant and clear. For revising the management of shoulder dystocia most obstetric personnel would use the video tutorial together with traditional textbooks. In conclusion, our video tutorial was considered by health personnel as a useful complementary training tool.
    Journal of Obstetrics and Gynaecology 10/2014; 35(5). DOI:10.3109/01443615.2014.969208 · 0.55 Impact Factor
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    • "Neonatal brachial plexus injuries (NBPI) occur during birth and are most often due to shoulder dystocia (van Ouwerkerk, van der Slujis, Nollet, Barkhof, & Sloof, 2000), when the infant's shoulder fails to pass or becomes impacted on the mother's pelvic bone (Gherman et al., 2006). Estimates of the incidence of NBPI vary, with a recent study suggesting that these injuries occur in approximately 1.5 per 1,000 live births in the United States (Foad, Mehlman, & Ying, 2008). "
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    ABSTRACT: Objective Owing to the possible visible nature and functional impairments associated with neonatal brachial plexus injuries (NBPI), the current study investigated the relations of injury severity, social support, and coping strategies to social difficulties and self-concept in youth with NBPI. Methods 88 children (aged 10–17 years) with NBPI and their parent(s) were recruited from a national organization and two brachial plexus clinics. Participants completed a variety of questionnaires during their scheduled clinic visits. Results More social support from classmates was associated with better self-concept and fewer social difficulties. Less frequent use of negative coping strategies was associated with better self-concept and fewer social difficulties and was a significant moderator of the relation between injury severity and self-concept. Conclusions Clinicians who work with children with NBPI should consider peer support and coping strategies when promoting the psychosocial functioning of these youth.
    Journal of Pediatric Psychology 10/2014; 40(3). DOI:10.1093/jpepsy/jsu086 · 2.91 Impact Factor
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    • "To a large extent, CF is unpredictable and unpreventable, as most cases occur following uncomplicated vaginal deliveries [1], [2], [5]. Several risk factors for CF have been identified in the literature, including fetal macrosomia [1]–[8], shoulder dystocia [3], [7], [9], [10], gestational diabetes mellitus (GDM)[1], oxytocin use to augment labor [2], operative delivery [9], prolonged second stage of labor [4] and meconium staining of amniotic fluid [1]. Among these factors, only increased fetal birth weight has been consistently associated with neonatal CF. "
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    ABSTRACT: Purpose To describe the risk factors and labor characteristics of Clavicular fracture (CF) and brachial plexus injury (BPI); and compare antenatal and labor characteristics and prognosis of obstetrical BPI associated with shoulder dystocia with obstetrical BPI not associated with shoulder dystocia. Methods This retrospective study consisted of women who gave birth to an infant with a fractured clavicle or BPI between January 2009 and June 2013. Antenatal and neonatal data were compared between groups. The control group (1300) was composed of the four singleton vaginal deliveries that immediately followed each birth injury. A multivariable logistic regression model, with backward elimination, was constructed in order to find independent risk factors associated with BPI and CF. A subgroup analysis involved comparison of features of BPI cases with or without associated shoulder dystocia. Results During the study period, the total number of vaginal deliveries was 44092. The rates of CF, BPI and shoulder dystocia during the study period were 0,6%, 0,16% and 0,29%, respectively. In the logistic regression model, shoulder dystocia, GDM, multiparity, gestational age >42 weeks, protracted labor, short second stage of labor and fetal birth weight greater than 4250 grams increased the risk of CF independently. Shoulder dystocia and protracted labor were independently associated with BPI when controlled for other factors. Among neonates with BPI whose injury was not associated with shoulder dystocia, five (12.2%) sustained permanent injury, whereas one neonate (4.5%) with BPI following shoulder dystocia sustained permanent injury (p = 0.34). Conclusion BPI not associated with shoulder dystocia might have a higher rate of concomitant CF and permanent sequelae.
    PLoS ONE 08/2014; 9(8):e104765. DOI:10.1371/journal.pone.0104765 · 3.23 Impact Factor
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