Shoulder dystocia

Shoulder dystocia
Suprapubic pressure being used in a shoulder dystocia
Specialty	Obstetrics
Symptoms	Retraction of the baby's head back into the vagina[1]
Complications	Baby: Brachial plexus injury, clavicle fracture[2] Mother: Vaginal or perineal tears, postpartum bleeding[3]
Risk factors	Gestational diabetes, previous history of the condition, operative vaginal delivery, obesity in the mother, an overly large baby, epidural anesthesia[2]
Diagnostic method	Body fails to deliver within one minute of the head[2]
Treatment	McRoberts maneuver, suprapubic pressure, Rubin maneuver, episiotomy, all fours, Zavanelli's maneuver followed by cesarean section[3][2]
Frequency	~ 1% of vaginal births[2]

Shoulder dystocia is when, after vaginal delivery of the head, the baby's anterior shoulder gets caught above the mother's pubic bone.^[3][1] Signs include retraction of the baby's head back into the vagina, known as "turtle sign".^[1] Complications for the baby may include brachial plexus injury, or clavicle fracture.^[2][1] Complications for the mother may include vaginal or perineal tears, postpartum bleeding, or uterine rupture.^[3][1]

Risk factors include gestational diabetes, previous history of the condition, operative vaginal delivery, obesity in the mother, an overly large baby, and epidural anesthesia.^[2] It is diagnosed when the body fails to deliver within three minutes of delivery of the baby's head.^[2] It is a type of obstructed labour.^[4]

Shoulder dystocia is an obstetric emergency.^[3] Initial efforts to release a shoulder typically include: with a woman on her back pushing the legs outward and upward, pushing on the abdomen above the pubic bone.^[3] If these are not effective, efforts to manually rotate the baby's shoulders or placing the woman on all fours may be tried.^[3][2] Shoulder dystocia occurs in approximately 0.4% to 1.4% of vaginal births.^[2] Death as a result of shoulder dystocia is very uncommon.^[1]