Shoulder Dystocia

Excerpt

Shoulder dystocia is a complication of vaginal delivery that occurs when the anterior fetal shoulder becomes impacted behind the maternal pubic symphysis. Less commonly, it occurs when the posterior shoulder becomes lodged behind the maternal sacral promontory. It is typically characterized by failure to deliver the fetal shoulders using the usual gentle downward traction and the need for additional obstetric maneuvers to deliver the infant successfully.

Shoulder dystocia is an obstetric emergency; most are unpredictable and unavoidable. The primary objective of any recommended management protocol is the prevention of neonatal asphyxia and brain injury. Therefore, any clinician involved with a vaginal delivery must have the clinical knowledge to promptly identify shoulder dystocia and be prepared to perform any additional obstetric maneuvers required to effect delivery. Competency in the recommended sequence of maneuvers and coordinated management with interprofessional clinicians can prevent permanent neonatal injury and asphyxiation when shoulder dystocia occurs. However, clinicians deficient in this clinical knowledge may become a mechanism of greater maternal and neonatal injury by attempting to resolve shoulder dystocia inappropriately. Consequently, healthcare professionals need enhanced competence when managing shoulder dystocia, updated knowledge, skills, and strategies to identify this complication, effectively intervene, and coordinate care. This will improve patient outcomes and reduce maternal and fetal morbidity and mortality.