shoulder dystocia

shoulder dystocia

Obstetrics An obstetrical emergency that occurs when the anterior shoulder of the fetus becomes lodged behind the superior symphysis pubis, preventing further delivery; SD is not always preventable, and is usually not recognized until after the head has been delivered, and gentle downward traction of the fetal head fails to accomplish delivery Incidence Up to 2% of deliveries–probably underreported Risk factors Maternal obesity >250 lbs–9 X risk, excess weight gain during pregnancy; DM–5-16.7% vs 1.7% in controls; postterm pregnancy–fetal growth does not stop at 40 wks; inertia of macrosomia; abnormal labor  with prolonged deceleration, prolonged 2^nd stage of labor; operative vaginal delivery–forceps, vacuum extraction Management Mobilize anesthesia and pediatric support ASAP; gentle attempt at downward traction on head and moderate fundal pressure; large episiotomy; suprapubic pressure at midline; attempt to rotate shoulder; fracture the clavicle; cleidotomy; symphysiotomy–rarely done in US; McRobert's manuever–flexing legs on abdomen to ↑ diameter of pelvic outlet; Wood's screw manuever–apply pressure to ventral surface of posterior shoulder; deliver posterior shoulder. See Dystocia.