The term dystocia refers to a long or difficult birth. Usually, shoulder dystocia takes place when the shoulder of the newborn gets stuck inside the body of the mother. There are certain risk factors that can cause shoulder dystocia but usually physicians are unable to prevent or predict it. Most cases of shoulder dystocia can be cured if handled correctly but some cases can cause lifelong problems.
What Is Shoulder Dystocia?
Shoulder dystocia usually occurs during a vaginal cephalic delivery in which the head of the fetus has been delivered but the shoulder becomes stuck behind the pubic bone. In this type of delivery, additional maneuvers are required. Shoulder dystocia of the posterior shoulder impacting on the sacral promontory is less common and results in more complications.
Shoulder Dystocia Causes
Shoulder dystocia can occur as a result of a number of causes. The possible causes may include the health of a mother at the time of delivery as well as certain characteristics and features of fetus at the time of delivery.
Possible causes of shoulder dystocia include:
- Diabetes in the mother
- A high maternal body mass index
- Prolonged first stage and second stage labor
- Delivery after the due date
- Assisted vaginal injury due to the usage of forceps of vacuum extraction
- Abnormal anatomy of the pelvis
- Induced labor
- A reaction to the epidural to prevent pain in labor
Shoulder Dystocia Symptoms
Shoulder dystocia can have a negative impact on both mother and child. The birth attendees should take clear notice of signs and symptoms of shoulder dystocia. The main shoulder dystocia symptoms may be visible at the time of delivery.
The most common symptoms of shoulder dystocia include:
- Shoulders that do not descend
- Difficulty in face and chin delivery
- Difficulty in retracting
- Fetal head restitution failure
- Downward traction on the fetal head
Shoulder Dystocia Side effects
Shoulder dystocia can cause physiological and biological damage in both mother and child. The side effects vary on the severity of shoulder dystocia. Side effects can range from mild to severe.
The possible side effects of shoulder dystocia in mothers are:
- Postpartum hemorrhage
- Perineal tears
- Vaginal lacerations
- Bladder rupture
- Cervical tears
- Uterine rupture
- Dislocation of sacroiliac joint
- Symphyseal separation
Possible symptoms of shoulder dystocia in infants are:
- Brachial plexus injury
- Humerus and clavicle fracture
- Hypoxic brain damage
- Pneumothorax, or a collection of gas between the chest wall and the lungs
Shoulder Dystocia Management
When a physician feels that shoulder dystocia has occurred, additional procedures are often needed. A process known as the McRoberts maneuver is often applied first as it is a simple, effective and rapid intervention. The maneuver involves pushing the mother’s legs back towards her abdomen. In order to improve the efficacy of the McRoberts maneuver, suprapubic pressure should be used. Training should be given to the maternity staff for shoulder dystocia at least annually in order to prevent damage when performing such maneuvers.
Shoulder Dystocia Treatment
When a diagnosis of shoulder dystocia has been made, several maneuvers are attempted in order to dislodge the baby’s shoulder in a vaginal delivery. The doctor may also opt for caesarian section if the maneuvers fail. When the baby is large, the physician usually opts for C-section. Treatments for potential side effects or complications are treated accordingly through rest, surgery, or medication.
Shoulder Dystocia Legal Considerations
Shoulder dystocia can be diagnosed before the baby is born. Physicians can do so by doing an ultrasound for the fetus. In case of mothers, if a mother is diabetic the physician knows about this beforehand. Shoulder dystocia is a cause of birth injury. It is possible for shoulder dystocia to be caused by the negligence of the attending medical professional. If you or your baby has suffered or continues to suffer from injuries related to shoulder dystocia, it is critical to speak with an experienced birth injury attorney in order to seek legal recourse.
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