Shoulder Dystocia - Birth Injury
Shoulder Dystocia
is a complication that occurs during birth in which the baby’s shoulder
is caught behind the pelvic bone of the mother. Shoulder dystocia is
difficulty in childbirth where the baby’s head is delivered, but the
shoulders require additional medical maneuvers to be properly
delivered. There are a number of variables that can affect the
likelihood of shoulder dystocia. Improper preparation for, and
mishandling of, shoulder dystocia by medical professionals can cause
serious maternal and fetal injury.
There are several risk factors that increase the chances of shoulder dystocia during delivery.
Fetal macrosomia, or large birth size is one indicator of shoulder
dystocia. Babies who weigh between five pounds eight ounces and eight
pounds thirteen ounces suffer from shoulder dystocia in 0.6 to 1.4
percent of all births. Babies who weight more than this have a five to
nine percent chance of suffering from shoulder dystocia. Maternal
factors also increase the likelihood of shoulder dystocia. Diabetes,
abnormal pelvic anatomy, a small birth canal, short stature, and
previous shoulder dystocia complications are all maternal factors that
increase the chances of shoulder dystocia.
Problems in delivery can also cause shoulder dystocia.
These include a protracted phase of first or second stage labor, and
forceps or vacuum delivery. Abnormally forceful or improperly
maneuvered vacuum delivery is the most common cause of delivery
complications that results in shoulder dystocia. This increases risks
for the infant and the mother. The baby is unable to breathe in the
position of shoulder dystocia so immediate responses are crucial to the
baby’s life. When responding to a baby in this position, the goal is to
allow enough room for the baby to shift into a better position.
No definitive cause is known for shoulder dystocia, but there are
certain factors that may increase this birth injury. Some factors
include a weight bigger than nine pounds, prolonged pregnancy, diabetic
mother or a mother weighing greater than two hundred pounds. About 23%
of cases occur when there are none of the above factors present.
Prevention of shoulder dystocia involves appropriate labor management
and skilled maneuvers during deliveries where shoulder dystocia may
occur. Risk factors for shoulder dystocia can be discovered via
ultrasound and should be evaluated during pregnancy. Women who are at a
greater risk for suffering from shoulder dystocia deliveries should be
informed of these risks and a medical plan should be developed
regarding how shoulder dystocia will be handled should it occur during
delivery.
Shoulder dystocia is identified
during the birth process when the head of the baby is delivered but
then retracts against the perineum (called the “turtle sign”). At this
point proper shoulder dystocia protocol should be utilized to prevent
injury and allow for the birth to occur with the least amount of
inflicted trauma. Medical sources indicate that induction of labor and
cesarean sections do not always reduce the likelihood of shoulder
dystocia.
Proper prevention techniques can
involve: seeking adequate medical help, episiotomy (cutting of the
maternal tissues involved in childbirth), maternal repositioning to
facilitate a smoother delivery (including leg positioning and mom going
onto all fours), the application of suprapubic pressure, and rotating
the position of the baby.
The consequences
of shoulder dystocia can harm the mother and the baby. Skeletal
injuries (especially to the collarbone), permanent brain damage,
uterine rupture and serious blood loss are examples of great
complications that can arise out of shoulder Maternal complications
include hemorrhaging, uterine rupture, rectovaginal fistula, and
bruising or tearing of the reproductive parts. Fetal complications
include brachial plexus palsy, clavicle fractures, loss of oxygen to
baby (with or without neurological damage), and possibly death.
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