Shoulder Dystocia

Chapter 62 - Shoulder Dystocia

from Section 6 - Late Prenatal – Obstetric Problems

Published online by Cambridge University Press: 15 November 2017

Joanna F. Crofts and

Edited by

Bernard Gonik and

David James: Affiliation:
University of Nottingham
Philip Steer: Affiliation:
Imperial College London
Carl Weiner: Affiliation:
University of Kansas
Bernard Gonik: Affiliation:
Wayne State University, Detroit
Stephen Robson: Affiliation:
University of Newcastle

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Summary

Shoulder dystocia is defined as a vaginal cephalic delivery that requires additional obstetric maneuvers to deliver the fetus after gentle traction has failed. It occurs when either the anterior shoulder impacts behind the maternal symphysis or, less commonly, the posterior shoulder impacts over the sacral promontory. Evidence-based algorithms for the management of shoulder dystocia recommend resolution maneuvers designed to improve the relative dimensions of the maternal pelvis (McRoberts’ position and all-fours position), reduce the diameter of the fetal shoulders (suprapubic pressure and delivery of the posterior arm) and/or move the fetal shoulders into a wider pelvic diameter (suprapubic pressure and internal rotational maneuvers).

Type: Chapter
Information: High-Risk Pregnancy
Management Options
, pp. 1775 - 1787

DOI: https://doi.org/10.1017/9781108349185 [Opens in a new window]

Publisher: Cambridge University Press

First published in: 2017

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References

Royal College Obstetricians and Gynaecologists. Shoulder Dystocia, 2nd edn. Green-top Guideline No. 42. London: RCOG, 2012. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg42/ (accessed March 2017).Google Scholar

American College of Obstetricians and Gynecologists. Clinical management guidelines for obstetricians and gynaecologists: shoulder dystocia. ACOG Practice Bulletins 2002 40: 593–7.Google Scholar

Gherman, RB, Chauhan, S, Ouzounian, JG, et al. Shoulder dystocia: the unpreventable obstetric emergency with empiric management guidelines. Am J Obstet Gynecol 2006; 195: 657–72.CrossRef Google Scholar PubMed

Hansen, A, Chauhan, SP. Shoulder dystocia: definitions and incidence. Semin Perinatol 2014; 38: 184–8.Google Scholar

Mollberg, M, Wennergren, M, Bager, B, Ladfors, L, Hagberg, H. Obstetric brachial plexus palsy: a prospective study on risk factors related to manual assistance during the second stage of labor. Acta Obstet Gynecol Scand 2007; 86: 198–204.Google Scholar

Beall, MH, Spong, CY, Ross, MG. A randomized controlled trial of prophylactic maneuvers to reduce head-to-body delivery time in patients at risk for shoulder dystocia. Obstet Gynecol 2003; 102: 31–5.CrossRef Google Scholar PubMed

Crofts, JF, Lenguerrand, E, Bentham, GL, et al. Prevention of brachial plexus injury: 12 years of shoulder dystocia training: an interrupted time-series study. BJOG 2016; 123: 111–18.Google Scholar

Maternal and Child Health Research Consortium. Confidential Enquiry Into Stillbirths and Deaths in Infancy (CESDI) 5th Annual Report: Focus Group Shoulder Dystocia. London: MCHRC, 1998, pp. 73–9.Google Scholar

Leung, TY, Stuart, O, Sahota, DS, et al. Head-to-body delivery interval and risk of fetal acidosis and hypoxic ischaemic encephalopathy in shoulder dystocia: a retrospective review. BJOG 2011; 118: 474–9.Google Scholar

Evans-Jones, G, Kay, SP, Weindling, AM, et al. Congenital brachial palsy: incidence, causes, and outcome in the United Kingdom and Republic of Ireland. Arch Dis Child Fetal Neonatal Ed 2003; 88: F185–9.CrossRef Google Scholar PubMed

Gherman, RB. Shoulder dystocia: an evidence-based evaluation of the obstetric nightmare. Clin Obstet Gynecol 2002; 45: 345–62.CrossRef Google Scholar PubMed

Ouzounian, JG, Korst, LM, Miller, DA, Lee, RH. Brachial plexus palsy and shoulder dystocia: obstetrical risk factors remain elusive. Am J Perinatol 2013; 30: 303–8.Google Scholar

NHS Litigation Authority. Ten Years of Maternity Claims: An Analysis of NHS Litigation Authority Data. London: NHS, 2012. http://www.nhsla.com/Pages/Publications.aspx?library=safety%7clearningfromclaims%7cmaternityclaimsdataproject (accessed March 2017).Google Scholar

Angelini, DJ, Greenwald, L. Closed claims analysis of 65 medical malpractice cases involving nurse-midwives. J Midwifery Womens Health 2005; 50: 454–60.CrossRef Google Scholar PubMed

Acker, DB, Sachs, BP, Friedman, EA. Risk factors for shoulder dystocia. Obstet Gynecol 1985; 66: 762–8.Google Scholar

Øverland, EA, Spydslaug, A, Nielsen, CS, Eskild, A. Risk of shoulder dystocia in second delivery: does a history of shoulder dystocia matter? Am J Obstet Gynecol 2009; 200: 506.e1–6.CrossRef Google Scholar PubMed

Mehta, SH, Sokol, RJ. Shoulder dystocia: risk factors, predictability, and preventability. Semin Perinatol 2014; 38: 189–93.Google Scholar

Nesbitt, TS, Gilbert, WM, Herrchen, B. Shoulder dystocia and associated risk factors with macrosomic infants born in California. Am J Obstet Gynecol 1998; 179: 476–80.Google Scholar

Langer, O, Berkus, MD, Huff, RW, Samueloff, A. Shoulder dystocia: should the fetus weighing greater than or equal to 4000 grams be delivered by cesarean section? Am J Obstet Gynecol 1991; 165: 831–7.Google Scholar

Modanlou, HD, Komatsu, G, Dorchester, W, Freeman, RK, Bosu, SK. Large-for-gestational-age neonates: anthropometric reasons for shoulder dystocia. Obstet Gynecol 1982; 60: 417–23.Google Scholar PubMed

Robinson, H, Tkatch, S, Mayes, DC, Bott, N, Okun, N. Is maternal obesity a predictor of shoulder dystocia? Obstet Gynecol 2003; 101: 24–7.Google Scholar

Backe, B, Magnussen, EB, Johansen, OJ, Sellaeg, G, Russwurm, H. Obstetric brachial plexus palsy: a birth injury not explained by the known risk factors. Acta Obstet Gynecol Scand 2008; 87: 1027–32.Google Scholar

Øverland, EA, Vatten, LJ, Eskild, A. Pregnancy week at delivery and the risk of shoulder dystocia: a population study of 2,014,956 deliveries. BJOG 2014; 121: 34–41.CrossRef Google Scholar

Gross, SJ, Shime, J, Farine, D. Shoulder dystocia: predictors and outcome. A five-year review. Am J Obstet Gynecol 1987; 156: 334–6.Google Scholar

Ouzounian, JG, Gherman, RB. Shoulder dystocia: are historic risk factors reliable predictors? Am J Obstet Gynecol 2005; 192: 1933–5.Google Scholar

Dyachenko, A, Ciampi, A, Fahey, J, et al. Prediction of risk for shoulder dystocia with neonatal injury. Am J Obstet Gynecol 2006; 195: 1544–9.Google Scholar

Rouse, DJ, Owen, J, Goldenberg, RL, Cliver, SP. The effectiveness and costs of elective cesarean delivery for fetal macrosomia diagnosed by ultrasound. JAMA 1996; 276: 1480–6.Google Scholar

Conway, DL, Langer, O. Elective delivery of infants with macrosomia in diabetic women: reduced shoulder dystocia versus increased cesarean deliveries. Am J Obstet Gynecol 1998; 178: 922–5.Google Scholar

Maso, G, Piccoli, M, Parolin, S, Restaino, S, Alberico, S. Diabetes in pregnancy: timing and mode of delivery. Curr Diab Rep 2014; 14: 506.Google Scholar

Supreme Court. Montgomery (Appellant) v Lanarkshire Health Board (Respondent) (Scotland). Judgment date 11 Mar 2015. Case ID: UKSC 2013/0136. https://www.supremecourt.uk/cases/uksc-2013-0136.html (accessed March 2017).Google Scholar

Crowther, CA, Hiller, JE, Moss, JR, et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005; 352: 2477–86.Google Scholar

Horvath, K, Koch, K, Jeitler, K, et al. Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis. BMJ 2010; 340: c1395.Google Scholar

Boulvain, M, Senat, MV, Perrotin, F,et al. Induction of labour versus expectant management for large-for-date fetuses: a randomised controlled trial. Lancet 2015; 385: 2600–5.CrossRef Google Scholar PubMed

Siassakos, D, Bristowe, K, Draycott, TJ, et al. Clinical efficiency in a simulated emergency and relationship to team behaviours: a multisite cross-sectional study. BJOG 2011; 118: 596–607.Google Scholar

Gonik, B, Allen, R, Sorab, J. Objective evaluation of the shoulder dystocia phenomenon: effect of maternal pelvic orientation on force reduction. Obstet Gynecol 1989; 74: 44–8.Google Scholar

Rubin, A. Management of shoulder dystocia. JAMA 1964; 189: 835–7.Google Scholar

Leung, TY, Stuart, O, Suen, SS, et al. Comparison of perinatal outcomes of shoulder dystocia alleviated by different type and sequence of manoeuvres: a retrospective review. BJOG 2011; 118: 985–90.Google Scholar

Sagi-Dain, L, Sagi, S. The role of episiotomy in prevention and management of shoulder dystocia: a systematic review. Obstet Gynecol Surv 2015; 70: 354–62.Google Scholar

Barnum, CG. Dystocia due to the shoulders. Am J Obstet Gynecol 1945; 50: 439–42.Google Scholar

Woods, CE, Westbury, NY. A principle of physics as applicable to shoulder delivery. Am J Obstet Gynecol 1943; 45: 796–804.CrossRef Google Scholar

Gross, TL, Sokol, RJ, Williams, T, Thompson, K. Shoulder dystocia: a fetal-physician risk. Am J Obstet Gynecol 1987; 156: 1408–18.CrossRef Google Scholar PubMed

Bruner, JP, Drummond, SB, Meenan, AL, Gaskin, IM. All-fours maneuver for reducing shoulder dystocia during labor. J Reprod Med 1998; 43: 439–43.Google Scholar

O’Leary, JA. Cephalic replacement for shoulder dystocia: present status and future role of the Zavanelli maneuver. Obstet Gynecol 1993; 82: 847–50.Google Scholar

Metaizeau, J, Gayet, C, Plenat, F. Les lesions obstetricales du plexus brachial. Chir Pediatr 1979; 20: 159–163.Google Scholar

Crofts, JF, Bartlett, C, Ellis, D, et al. Training for shoulder dystocia: a trial of simulation using low-fidelity and high-fidelity mannequins. Obstet Gynecol 2006; 108: 1477–85.CrossRef Google Scholar PubMed

Satin, AJ. Perfecting practice. Obstet Gynecol 2008; 112: 746–7.Google Scholar

Crofts, JF, Ellis, D, Draycott, TJ, et al. Change in knowledge of midwives and obstetricians following obstetric emergency training: a randomised controlled trial of local hospital, simulation centre and teamwork training. BJOG 2007; 114: 1534–41.Google Scholar

Sørensen, JL, Løkkegaard, E, Johansen, M, et al. The implementation and evaluation of a mandatory multi-professional obstetric skills training program. Acta Obstet Gynecol Scand 2009; 88: 1107–17.Google Scholar

Russell, L, Nyhof-Young, J, Abosh, B, Robinson, S. An exploratory analysis of an interprofessional learning environment in two hospital clinical teaching units. J Interprof Care 2006; 20: 29–39.Google Scholar

Crofts, JF, Attilakos, G, Read, M, Sibanda, T, Draycott, TJ. Shoulder dystocia training using a new birth training mannequin. BJOG 2005; 112: 997–9.Google Scholar

Deering, S, Poggi, S, Macedonia, C, Gherman, R, Satin, AJ. Improving resident competency in the management of shoulder dystocia with simulation training. Obstet Gynecol 2004; 103: 1224–8.Google Scholar

Inglis, SR, Feier, N, Chetiyaar, JB, et al. Effects of shoulder dystocia training on the incidence of brachial plexus injury. Am J Obstet Gynecol 2011; 204: 322.e1–6.Google Scholar

Draycott, TJ, Crofts, JF, Ash, JP, et al. Improving neonatal outcome through practical shoulder dystocia training. Obstet Gynecol 2008; 112: 14–20.Google Scholar

Grobman, WA, Miller, D, Burke, C, et al. Outcomes associated with introduction of a shoulder dystocia protocol. Am J Obstet Gynecol 2011; 205: 513–17.CrossRef Google Scholar PubMed

Walsh, JM, Kandamany, N, Ni Shuibhne, N, et al. Neonatal brachial plexus injury: comparison of incidence and antecedents between 2 decades. Am J Obstet Gynecol 2011; 204: 324.e1–6.Google Scholar

MacKenzie, IZ, Shah, M, Lean, K, et al. Management of shoulder dystocia: trends in incidence and maternal and neonatal morbidity. Obstet Gynecol 2007; 110: 1059–68.Google Scholar

Crofts, JF, Fox, R, Ellis, D, et al. Observations from 450 shoulder dystocia simulations: lessons for skills training. Obstet Gynecol 2008; 112: 906–12.CrossRef Google Scholar PubMed

Jan, H, Guimicheva, B, Gosh, S, et al. Evaluation of healthcare professionals’ understanding of eponymous maneuvers and mnemonics in emergency obstetric care provision. Int J Gynaecol Obstet 2014; 125; 1–20.CrossRef Google Scholar PubMed

Siassakos, D, Crofts, JF, Winter, C, Weiner, CP, Draycott, TJ. The active components of effective training in obstetric emergencies. BJOG 2009; 116: 1028–32.CrossRef Google Scholar PubMed

Graham, EM, Forouzan, I, Morgan, MA. A retrospective analysis of Erb’s palsy cases and their relation to birth weight and trauma at delivery. J Matern Fetal Med 1997; 6: 1–5.Google Scholar PubMed

Ouzounian, JG, Korst, LM, Phelan, JP. Permanent Erb palsy: a traction-related injury? Obstet Gynecol 1997; 89: 139–41.Google Scholar

Sandmire, HF, DeMott, RK. Erb’s palsy without shoulder dystocia. Int J Gynaecol Obstet 2002; 78: 253–6.Google Scholar

Lerner, HM, Salamon, E. Permanent brachial plexus injury following vaginal delivery without physician traction or shoulder dystocia. Am J Obstet Gynecol 2008; 198 (3): e7–8.Google Scholar

Sandmire, HF, DeMott, RK. Erb’s palsy: concepts of causation. Obstet Gynecol 2000; 95: 941–2.Google Scholar

Draycott, T, Sanders, C, Crofts, J, Lloyd, J. A template for reviewing the strength of evidence for obstetric brachial plexus injury in clinical negligence claims. Clin Risk 2008; 14: 96–100.Google Scholar