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 Bulletins – ACOG

Click here to view options to read entire bulletin. However, they generally fall into three categories:. Moreover, there is a higher rate of injury and severity of injury in newborns whose delivery represents a recurrent shoulder dystocia. A nerve that is partially torn can often regenerate itself with restoration of function; ruptured or avulsed nerves do not regenerate and cannot be repaired.

No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. Inexperienced observers often draw a host of erroneous impressions as to what has happened in such a situation. Unfortunately its data has been abused in the medical-legal world as setting a ceiling for force used—when, in fact, the paper only examined forces in two babies who had a shoulder dystocia and only one with a brachial plexus injury—and that one only temporary!

Diagnosis and differential diagnosis Definition of shoulder dystocia Incidence of shoulder dystocia Risk factors for shoulder dystocia Macrosomia Gestational diabetes Previous shoulder dystocia Instrumental vaginal delivery Suggested clinical approach to “risk factors” Prevention 3. What every clinician should know 2. Gonik’s mathematical “proof” that endogenous forces—uterine contractions and maternal pushing—can be 4 to 9 times greater than exogenous forces—physician traction—added additional support to those formulating alternative hypotheses regarding the causation of brachial plexus injuries.

Although shoulder dystocia is, in most cases, unpredictable and unpreventable, there are certain precautions that can be taken which will enable you to be best prepared when it does occur:.

Abstract Shoulder dystocia is an unpredictable and unpreventable obstetric emergency that places the pregnant woman and fetus at risk of injury. This diameter is narrower than the oblique diameter, increasing the chances that the baby’s anterior shoulder will get stuck behind the maternal symphysis.

The ACOG Practice Bulletin on Shoulder Dystocia says, “because most subsequent deliveries will not be complicated by shoulder dystocia, the benefit of universal elective cesarean delivery is questionable in patients who have such a history of shoulder dystocia. Episiotomies are only useful if there is insufficient room in the vagina for the clinician to put his or her hand inside to perform necessary maneuvers.


Management There are seven aspects to management of shoulder dystocia emergencies, each of which is vitally important in increasing the chances of a safe, successful outcome: This Practice Bulletin does a good job of summarizing issues of the predictability of shoulder dystocia and of physician management of it; the bulletin does not go into specific maneuvers or protocols.

Most other proposed risk factors for shoulder dystocia exert their influence because of their association with increased birth weight. The total head-to-body delivery time Evaluation of the baby’s status after delivery Documentation of the conversation with parents following delivery 5.

Allen had published a similar article in Obstet Gynecol Additionally, the incidence and severity of neonatal injury from shoulder dystocia is higher in babies born of diabetic mothers Table II. Conclusion Shoulder dystocia remains—and is likely to continue to remain—an unpredictable and unpreventable obstetrical emergency.

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 consensus 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: A shoulder dystocia presents with the inability of the anterior fetal shoulder to emerge from the vagina with maternal pushing and routine physician traction after delivery of the head.

Am J Obstet Gynecol. Brachial plexus injuries can affect any or all of the C-5 to T-1 nerve roots. Moreover, cesarean sections in this frequently obese, often diabetic patient population are not necessarily benign procedures.

Lerner Jump to Section Shoulder dystocia 1. There are a limited number of proven risk factors for shoulder dystocia.

While other maneuvers to resolve shoulder dystocia are described, they are rarely employed, either because of their high rate of complications or the difficulty of performing them Table IV. 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. Can early induction of labor decrease the incidence of macrosomia and thus decrease the incidence of shoulder dystocia and permanent brachial plexus injury?


The purpose of this document is to provide clinicians with evidence-based information regarding management of pregnancies and deliveries at risk of or complicated by shoulder dystocia.

A Problem for Gene Editing in Cancer? 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.

ACOG Practice Bulletin #178: Shoulder Dystocia

Be aware of each patient’s risk factors and evaluate each patient throughout their pregnancy to identify those at highest risk for shoulder dystocia. Postpartum atrophy of the bladder due to prolonged compression. Despite this clear linkage between fetal macrosomia and shoulder dystocia, there are significant problems with clinicians pgactice to use suspected fetal macrosomia to predict which patients will experience shoulder dystocia at delivery:.

Prognosis and outcome Controversies regarding shoulder dystocia Conclusion 6. What causes brachial plexus injuries? Rouse and Owen showed that the policy of prophylactic cesarean delivery for suspected macrosomia would require several thousand cesarean deliveries and millions of dollars to avert a single permanent brachial plexus injury.

Other injuries sometimes seen are: Klumpke’s palsy involves damage of the C-8 and T-1 nerve roots. Before cutting an umbilical cord, the deliverer must be very certain that the entire baby will emerge within seconds thereafter. In fact, the article does no such thing. Stretching zhoulder the brachial plexus nerves by inappropriate physician traction Damage to the brachial plexus nerves despite appropriate traction and delivery maneuvers due to the intrinsic variation in the strength of nerve fibers between individual neonates i.

Women’s Health Care Physicians

Rather, it was found that in nondiabetic patients, labor induction doubled the risk of cesarean section without reducing the rate of shoulder dystocia or newborn morbidity. Induction of labor versus expectant management in macrosomia: Comparing clinician-applied loads for routinedifficult, and shoulder dystocia deliveries.

Ask that extra nursing staff, a pediatrician, an anesthesiologist, and another obstetrician be called to assist.