Shoulder Dystocia

From WikiParenting

Shoulder dystocia happens when a baby’s shoulders become stuck behind the mother’s pubic bone during childbirth. The condition happens in about of 1 out of 100 deliveries in the United States. The condition is a medical emergency and can result in an emergency cesarean section or death of the baby.

[edit] How it happens

The baby’s head is delivered normally, but the baby’s shoulder is unable to progress through the canal because it has become trapped under the mother’s pubic bone.

[edit] Causes

There is no one exact cause of shoulder dystocia. There are risk factors that raise the chance of shoulder dystocia, however, and the factors can be maternal or fetal – or both. Maternal risk factors are:

• Abnormal pelvic anatomy
• Gestational diabetes
• Post date pregnancy
• Short stature
• Shoulder dystocia in a previous delivery

Fetal risk factors are:

• Suspected macrosomia

Other risk factors are related to the delivery itself. The following situations are associated with higher rates of shoulder dystocia:

• Use of forceps or vacuum to assist the delivery
• Long and drawn out first stage of labor, the active phase
• Prolonged second stage of labor

[edit] Complications

Serious complications can result if the baby’s shoulder’s become stuck behind the pubic bone. ===Maternal complications=== Complications for the mother include:

• Postpartum hemorrhage
• Deep, 3rd or 4th degree episiotomy tears
• Uterine rupture
• Damage to the birth canal
• Rectovaginal fistula – a condition that happens during traumatic childbirth. A canal is formed between the rectum and the vagina. The condition is very painful and allows feces to escape through the vagina.
• Pubic pain (Symphsis Pubic Dysfunction - SPD)

[edit] Fetal compliations

About 20 out of 100 babies that have shoulder dystocia during childbirth will have an injury. These injuries range from temporary and mild to permanent. Complications that can affect the baby include:

• Brachial plexus injury – Nerve damage to the arm
• Collarbone fracture
• Lack of oxygen to the brain, with or without permanent damage
• Fractured upper arm bone
• Death

[edit] Diagnosis

Diagnosis of shoulder dystocia is made when the shoulders do not follow the head during childbirth. Typically, the head will deliver normally and then the neck will be drawn back into the birth canal as the shoulders become stuck. This drawing back of the neck is termed the “turtle sign” that indicates the condition.

[edit] Treatment

Healthcare providers generally move through a series of treatment options to deliver the baby as soon as possible. These options include various maneuvers to change the baby’s position to allow birth to continue, and cesarean section.