After shoulder dystocia: managing the subsequent pregnancy and delivery

Abstract

Among risk factors for shoulder dystocia, a prior history of delivery complicated by shoulder dystocia is the single greatest risk factor for shoulder dystocia occurrence, with odds ratios 7 to 10 times that of the general population. Recurrence rates have been reported to be as high as 16%. Whereas prevention of shoulder dystocia in the general population is neither feasible nor cost-effective, intervention efforts directed at the particular subgroup of women with a prior history of shoulder dystocia can concentrate on potentially modifiable risk factors and individualized management strategies that can minimize recurrence and the associated significant morbidities and mortality.

Figure 1:. Postpartum CT Pelvimetry Following Shoulder Dystocia.

CT images were obtained from a grand grand multiparous (para 9) woman immediately following delivery, which was complicated by shoulder dystocia. a) largest transverse diameter; b) anteroposterior diameter (sacral promontory to top of pubic symphysis); image shows marked angulation of sacrococcygeal joint consistent with healed fracture; c) interspinous diameter; d) intertuberous diameter. Acquired pelvic deformity, likely sustained during earlier delivery, probably contributed to “high-riding” anterior shoulder resulting in shoulder dystocia.