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Home : Shoulder Dystocia
Shoulder Dystocia
What is Shoulder Dystocia?
Dystocia is an abnormal or difficult childbirth or labor. Shoulder dystocia is a specific case of whereby the anterior(front) shoulder of the child is unable to pass below the pubic symphysis, the joint between the pubic bones at the front of the pelvis. This condition also occurs when the child requires significant manipulation to pass below this area. The single most common risk factor for shoulder dystocia is the use of a vacuum extractor or forceps during delivery.Shoulder dystocia occurs in approximately one half of one percent of all deliveries. Given that there are 4 million babies born each year in the United States, this delivery complication will be experienced by roughly 20,000 women a year. The larger the baby, the more likely it is to occur. However, even with very large babies shoulder dystocia occurs only occasionally and sporadically.
It is diagnosed initially when the shoulders fail to deliver shortly after the fetal head. At an otherwise normal delivery, just after the baby's head has emerged, the neck suddenly retracts back against the mother's perineum causing the baby's cheeks to puff out. The experienced obstetrician knows at this point that the baby's anterior shoulder is caught on the pubic bone and there is a rapidly closing window of time the doctor has to act. Failing the proper actions at this point can result in lifelong injury to the child, including a severe palsy, brain damage, or death in the immediate term.
It remains among the most common fetal complications, leading largely to brachial plexus palsies, which occur in 4 to 15 percent of infants. In fact, following shoulder dystocia deliveries, 20% of babies will suffer some sort of injury, either temporary or permanent. The most common of these injuries are damage to the brachial plexus nerves, fractured clavicles, fractured humeri, contusions and lacerations, and birth asphyxia. Brachial plexus injuries such as palsies refer to the brachial plexus nerve network, a network of nerves that sends signals from the spine to the shoulder, arm, and hand. Brachial plexus injuries are caused by damage to those nerves, and specific birth injuries such as Erb's Palsy or Klumpke palsy are part of a group of delivery-related issues.
The interest obstetricians have in finding solutions to this condition has been heightened in the last two decades by the increasing influence of medical-legal issues on the practice of medicine. As regards shoulder dystocia, it is frequently the case that when a brachial plexus injury occurs, an obstetrician will be charged with negligence. Such claims are now so frequent that law suits related to shoulder dystocia deliveries result in the second largest category of indemnity payments in obstetrics, exceeded only by birth asphyxia.
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