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arrest of normal labor after delivery of the head by impaction of the anterior shoulder against the symphysis pubis.
shoulder dystociaObstetrics 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 2nd 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.
shoul·der dys·to·ci·a(shōl'dĕr dis-tō'sē-ă)
Arrest of normal labor after delivery of the head by impaction of the anterior shoulder against the symphysis pubis.