Wednesday, January 28, 2009

Shoulder Dystocia: The Basics

Posted by Benjamin B. Broome

According to the World Health Organization, shoulder dystocia is simply when the fetal head has been delivered but the shoulders are stuck and cannot be delivered. Although the vast majority of cases we have seen at MLA deal with the anterior (front) shoulder being stuck behind the pubic symphysis of the mother, we have seen one or two cases involving the posterior shoulder being stuck behind a portion of the sacrum.

While most cases of shoulder dystocia occur with no warning, litigation primarily revolves around the failure to recognize or manage this condition. According to the American Academy of Family Physicians, "calm and effective management of this emergency is possible with recognition of the impaction and institution of specified maneuvers, such as the McRoberts maneuver, suprapubic pressure, internal rotation, or removal of the posterior arm, to relieve the impacted shoulder and allow for spontaneous delivery of the infant."

To fully appreciate the issue of shoulder dystocia, one must understand the anatomy and role of the brachial plexus. Mismanagement of shoulder dystocia can lead to severe injuries to the brachial plexus including stretch injuries, partial tearing and even complete avulsion. These injuries can result in permanent developmental dysfunction of the affected arm with life long consequences.

Shoulder dystocia birth injury animation.