incidence of shoulder dystocia among vaginal deliveries e Practice Bulletin Shoulder Dystocia .. these resources at –Info/Shoulder. Along with the American College of Obstetricians and Gynecologists (ACOG) practice bulletin on shoulder dystocia, guidelines from England, Canada, Australia. Request PDF on ResearchGate | On Feb 1, , Robert J Sokol and others published ACOG practice bulletin: Shoulder dystocia. Number 40, November

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Practice Bulletin No Shoulder Dystocia.

Stretching of the brachial nerves by endogenous forces—maternal pushing and uterine contractions. United Brachial Plexus Network.

When a clinician suspects that there is an increased risk of shoulder dystocia shouldeg a given patient, he or she should do the following:. Lerner Jump to Section Shoulder dystocia 1.

Direct crushing pressure of the brachial plexus nerves against the maternal pubic bone caused by the endogenous forces of uterine contractions and maternal expulsive efforts. A comparison of endogenous and exogenous forces”. Moreover, there is a higher rate of injury and severity of injury in newborns whose delivery represents a practicf shoulder dystocia.

What causes brachial plexus injuries? Prognosis and outcome Controversies regarding shoulder dystocia Conclusion 6.

Other purported risk factors for shoulder bulleitn The bottom line is this: Suprapubic pressure Figure 3 is pressure applied just above the maternal symphysis pubis to the anterior shoulder of the fetus.

The brachial plexus Figure 5 is a series of nerves whose roots lie between C-5 and T Use terms that convey an accurate sense of the magnitude of the force used: This seminal article was one of the first to evaluate from actual medical records not discharge summaries or birth certificates risk factors for shoulder dystocia.

Rotational Maneuver In Rubin’s maneuver Figure 4the posterior aspect of either shoulder is pushed. Key Articles Acker D. It is thought that when a neonate’s shoulders get stuck during a shoulder dystocia delivery, it is because instead of the shoulders descending into the wider oblique diameter of the maternal pelvic outlet, the shoulders instead descend in an anterior-posterior orientation. Obstetricians and society will have to make a decision as to the number of unnecessary cesarean sections it is willing to have performed in order parctice prevent a single case of permanent brachial plexus injury.

Effects of a policy of elective cesarean delivery in cases of suspected fetal macrosomia on the incidence of brachial plexus injury and the rate of cesarean delivery. This ratio is even higher if both vacuum and forceps are used sequentially. Am J Obstet Gynecol.


Shoulder Dystocia and Birth Injury. A comparison of endogenous and exogenous sources. The opinions expressed in this material are those shoilder the authors and do not necessarily reflect views of the March of Dimes.

ACOG Practice Bulletin #178: Shoulder Dystocia

Studies have shown that prepregnancy, hulletin, and intrapartum risk factors have extremely poor predictive value for shoulder dystocia. Risk factors for shoulder dystocia While many factors have been cited as increasing the risk for shoulder dystocia, careful analysis shows that there are only four primary risk factors: Notify both the labor nurse and the supervising charge nurse of the increased risk of shoulder dystocia with this delivery.

Powered By Decision Support in Medicine. An in utero injury?

Risk factors for shoulder dystocia: When the entire chain of brachial plexus nerves are injured—a pan-brachial plexus injury C5-T1 —all of the muscles of the arm are affected. Family and friends observing the delivery see a relatively calm labor room erupt into a frenzy of activity with voices becoming tense and multiple medical practitioners coming and going. This person should call out loud each second interval that passes so that the team is constantly aware of the duration of the shoulder dystocia.

An in utero injury? Perform a routine “shoulder dystocia review” at or around 36 weeks gestation looking for: This results in Horner’s syndrome: In babies of diabetic mothers, the risk of shoulder dystocia in any weight group is 2. Relationship between birth weight and shoulder dystocia Most other proposed risk factors for shoulder dystocia exert their influence because of their association with increased birth weight.

The reason for the increased risk of shoulder dystocia in these babies has to do with their different growth morphology compared with babies of nondiabetic mothers. Below are some of the features that any such documentation record should include:. The McRoberts positioning works not by changing the actual dimensions of the maternal pelvis, but by straightening out the sacrum relative to the lumbar spine.

Alert medical personnel in the room to the presence of a shoulder dystocia. Not only is this a tremendous tragedy for each child and family involved, but a very large percentage of these cases wind up in litigation.

Shoulder Dystocia

Predelivery estimate of fetal weight and pelvic capacity The timing of the active phase and the second stage of labor The form of anesthesia that was in place, if shouldef When and how the shoulder dystocia was diagnosed Whether assistance of other personnel was called for Whether or not an episiotomy was made A description of the various maneuvers used and how long each was attempted A description of the estimation of force applied at various stages of resolution attempts Use terms that convey an accurate sense of the magnitude of the force used: The second concern is the ever-present fear in the mind of every practicing obstetrician that if a rpactice is injured during a shoulder dystocia delivery, rightly or wrongly the obstetrician will be held to be at fault in the lawsuit that will almost certainly follow.


While it is universally acknowledged that inappropriate traction on a baby’s head during an attempt to resolve a shoulder dystocia can cause a brachial plexus injury, the dysfocia view – as expressed in the ACOG Practice Bulletin on shoulder dystocia and in the major obstetrical textbooks – is that there are multiple potential etiologies for brachial plexus injury see Figure 5: McRoberts Maneuver Suprapubic pressure Suprapubic pressure Figure 3 is pressure applied just above the shoulver symphysis pubis to the anterior shoulder of the fetus.

This occurs when the long axis of the baby’s body is pushed downward while its anterior shoulder is trapped behind the mother’s pubic bone. However, they generally fall into three categories:.

The proximity of some portions of the cervical sympathetic nerve chain to the C-8 and T-1 nerve roots sometimes leads to sympathetic nerve damage when there is a severe brachial plexus injury. Other maneuvers While other dhoulder to resolve shoulder dystocia are shouldrr, they are rarely employed, either because of their high rate of complications or the difficulty of performing them Table IV.

Deliveries requiring mid vacuum or forceps result in rates of shoulder dystocia that are 4. Make the management of this emergency as deliberate dystocua efficient as possible. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC.