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Shoulder Dystocia: Risk Factors and Prevention
Author(s) -
Hassan Adnan A.
Publication year - 1988
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1988.tb01634.x
Subject(s) - shoulder dystocia , cephalopelvic disproportion , medicine , shoulders , caesarean section , obstetrics , vaginal delivery , surgery , pregnancy , genetics , biology
EDITORIAL COMMENT: Shoulder dystocia or impacted shoulders occurs in 2 4 per 1,000 deliveries in most reports. However, in this editor's opinion, some difficulty with delivery of the shoulders is encountered in 20 — 40 per 1,000 vaginal deliveries, and is often the result of occipitoposterior position with nonrotation of the shoulders. In this series of 41 cases there were 14 operative vaginal deliveries but, to my surprise, arrest of the occiput posterior to the transverse diameter did not rate a mention! Shoulder dystocia should be anticipated when a fetal head which is on view in the occipitoanterior position at the height of a contraction, recedes to the midpelvis and rotates to the occipitolateral position after the contraction (and the mother's voluntary expulsive efforts) ceases. The problem is probably more common with epidural analgesia, and should be anticipated in all midforceps deliveries, especially when there are signs of cephalopelvic disproportion. The author states that ‘the majority of cases of shoulder dystocia can be anticipated;’ he infers that elective Caesarean section should be performed when clinical judgement plus ultrasonographic assessment indicates fetal birth‐weight of 4,500 g or more — in this series of 19,000 vaginal deliveries, shoulder dystocia occurred in approximately 1 in 5 such infants. The clinician must be alert to recognize the 1 in 100 fetus that will have a birth‐weight of 4,500 g or more. Another indication for elective Caesarean section to avoid shoulder dystocia is the multipara who suffered this complication in a previous delivery and again has a fetus of ample proportions. Summary: Failure of the shoulders to deliver after delivery of the head is known as shoulder dystocia. The risk factors associated with its occurrence were examined in women delivering vaginally at Jordan University Hospital. The profile of the patient most likely to present with shoulder dystocia was determined to be a multiparous, obese patient, over 42 weeks' gestation in a pregnancy complicated by preedampsia or diabetes with an infant weighing 4,500 g or more. Neonatal complications were noted to be high. There was no maternal death but 4 stillborn infants were delivered and 1 died in the immediate neonatal period.