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Chapter 14 - Shoulder Dystocia

from Part II - INTRAPARTUM AND POSTPARTUM

Published online by Cambridge University Press:  07 May 2010

John Patrick O'Grady ,
Martin L. Gimovsky ,
Lucy A. Bayer-Zwirello  and
Kevin Giordano
By
James J. Nocon
John Patrick O'Grady
Affiliation:
Tufts University, Massachusetts
James J. Nocon
Affiliation:
Associate Professor, Department of Obstetrics and Gynecology Indiana University School of Medicine Indianapolis, Indiana
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Summary

This chapter reviews and examines the best evidence available about the nature and scope of shoulder dystocia, including reasonable management options and the challenging ethical and legal aspects surrounding this common obstetric emergency. The range of injuries to the newborn following a shoulder dystocia typically include trauma to the brachial plexus or phrenic nerve, fractures of the clavicle or humerus, neonatal asphyxia, and even death. From a medicolegal perspective, any reasonable method to resolve the impacted anterior shoulder conforms to the level of care expected of the average competent physician. If the physician can articulate a reasonable basis for the clinical judgment, and that information is documented in the medical record, then the physician has the best defense against a medicolegal entanglement. Acute management of dystocia remains a major problem. Some practitioners, on encountering a shoulder dystocia, fail to approach the problem systematically and sometimes panic.

Keywords

anterior shoulderbrachial plexus palsyneonatal asphyxiatraumatic deliveryobstetric emergencyshoulder dystocia
Type
Chapter
Information
Operative Obstetrics , pp. 348 - 369
Publisher: Cambridge University Press
Print publication year: 2008

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