incidence of shoulder dystocia among vaginal deliveries e Practice Bulletin Shoulder Dystocia .. these resources at –Info/Shoulder. Along with the American College of Obstetricians and Gynecologists (ACOG) practice bulletin on shoulder dystocia, guidelines from England, Canada, Australia. Request PDF on ResearchGate | On Feb 1, , Robert J Sokol and others published ACOG practice bulletin: Shoulder dystocia. Number 40, November

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It is not particularly important whether it is the anterior or posterior shoulder or its front or back surface that is pushed during rotational maneuvers. Medical Legal Art animation available. It is vital, therefore, for the delivering clinician to make time to sit and talk to the family and friends after the delivery and to explain what really transpired and why. An in utero injury? The goal of this maneuver is to bukletin the fetal shoulder away from its direct anterior-posterior orientation in the maternal pelvis into an oblique position.

While there is a disclaimer on the first page stating, “These guidelines should not be construed as dictating an exclusive course of treatment or procedure,” in reality, these guidelines are considered de facto national standards of care.

Women’s Health Care Physicians

Postpartum atrophy of the bladder due to prolonged compression. This has been demonstrated repeatedly in innumerable studies over multiple decades. The total head-to-body delivery time Evaluation of the baby’s status after delivery Documentation of the conversation with parents following delivery 5.

The statistics for fracture of the humerus are similar.

Diagnosis A shoulder dystocia presents with the inability of the anterior fetal shoulder to emerge from the vagina with maternal pushing and routine physician traction after delivery of the head. Shoulder dystocia occurs when there is an inability to deliver a baby’s shoulders after its head has emerged. Counsel such patients as to their risk of having a shoulder dystocia at delivery, and let them know their options and the pros and cons of these options.


Conclusion Shoulder dystocia remains—and is likely to continue to remain—an unpredictable and unpreventable obstetrical emergency. Careful and complete documentation of shoulder dystocia deliveries and the dystodia to them is vital.

ACOG Practice Bulletin # Shoulder Dystocia

Suprapubic pressure must be distinguished from fundal pressure, in which downward pressure is applied to the top of the uterus.

All xcog supposed risk factors for shoulder dystocia turn out to merely be markers in one form or another of the above.

This diameter is narrower than the oblique diameter, increasing the chances that the baby’s anterior shoulder will get stuck behind the maternal symphysis. This theoretical framework squares with the many reports of brachial plexus injuries from cesarean section deliveries, when there was no shoulder dystocia, and with the observation of the turtle sign. The purpose of this document is to provide clinicians with evidence-based information regarding management of pregnancies and deliveries at risk of or complicated by shoulder dystocia.

Practice Bulletins – ACOG

You documented this discussion. Abstract Shoulder dystocia is an unpredictable and unpreventable obstetric emergency that places the pregnant woman and fetus at risk of injury.

Given that there are approximately 4 million babies born in the United States each year—roughly 3 million by vaginal delivery—there will be approximately babies each year in the United States born with birth-related permanent brachial plexus injuries. Again, the majority of those who have studied shoulder dystocia would answer “No. There are a limited number of proven risk factors for shoulder dystocia.

The injury to Aacog to C-7 in Erb’s palsy results in paralysis or weakness of the shoulder muscles, elbow flexors, and forearm supinators. Prediction of risk for shoulder dystocia with neonatal injury. Macrosomia There is a direct linkage between birth weight and the risk of shoulder dystocia.

High rates pdactice success have been reported with the use of rotational maneuvers to resolve shoulder dystocias. American Academy of Family Physicians. Maneuvers McRoberts maneuver The McRoberts maneuver Figure 2 is the most commonly used shoulder dystocia resolution maneuver.

The McRoberts maneuver Figure 2 is the most commonly used shoulder dystocia resolution maneuver. Practice bulletin number Key Articles Acker D. Stretching of the brachial plexus nerves by inappropriate physician traction Damage to the brachial plexus nerves despite appropriate traction and delivery maneuvers due to the intrinsic variation in the strength of nerve fibers between individual neonates i.


Fetal death Prolonged hypoxia due to 1 a shoulder dystocia that cannot be resolved or 2 trauma from overly vigorous efforts to resolve a shoulder dystocia can in extremely rare cases result in fetal demise. In the Spong study, 60 seconds was found to be approximately two standard deviations above the mean value for head-to-body delivery time in uncomplicated shoulder dystocia deliveries.

Williams Obstetrics, 21st Edition. The brachial plexus Figure 5 is a series of nerves whose roots lie between C-5 and T By default, you will immediately become the leader of what must instantly become a high-performance team. While it is universally acknowledged that inappropriate traction on a baby’s head during an attempt to resolve a shoulder dystocia can cause a brachial plexus injury, the consensus view – as expressed in the ACOG Practice Bulletin on shoulder dystocia and in the major obstetrical textbooks – is that there are multiple potential etiologies for brachial plexus injury see Figure Perform a routine “shoulder dystocia review” at or around bukletin weeks gestation looking for: Other maneuvers While other maneuvers praftice resolve shoulder dystocia are described, they are rarely employed, either because of their high rate of complications or the difficulty of performing them Table IV.

Can acgo induction of labor decrease the incidence of macrosomia and thus decrease the incidence of shoulder dystocia and permanent brachial plexus injury? Complications Neonatal injury What causes brachial plexus injuries? Although shoulder dystocia is, in most cases, unpredictable and unpreventable, there are certain precautions that can be taken which will enable you to be best prepared when it does occur:.