Shoulder Dystocia



Shoulder Dystocia


Steven L. Clark

Michael A. Belfort



GENERAL PRINCIPLES





RISK FACTORS



  • Multiple risk factors for shoulder dystocia have been identified. Unfortunately, most of these are common, nonspecific, and not helpful in clinical management.


  • Three risk factors, however, have sufficient predictive value to impact clinical management to avoid shoulder dystocia. In the presence of any of these risk factors, cesarean delivery should be considered to avoid shoulder dystocia.



    • Large for gestational age: The risk of shoulder dystocia is directly related to the weight of the fetus. The American College of Obstetricians and Gynecologists has recommended consideration of cesarean delivery for infants with an estimated weight of ≥5,000 g, or ≥4,500 g for an infant of a diabetic mother.


    • Midpelvic arrest of descent with an estimated fetal weight exceeding 4,000 g: Under such circumstances, cesarean delivery is preferred over operative vaginal delivery.


    • Previous shoulder dystocia: Although some authorities suggest that cesarean is indicated only if a previous shoulder dystocia resulted in permanent brachial plexus injury, others, including us, feel it unwise to attempt vaginal delivery after a prior shoulder dystocia event. Unless there is reason to believe that the infant will be significantly smaller than the previous child, many experts recommend cesarean delivery.


  • It is important to emphasize that most infants with shoulder dystocia will have none of these risk factors.


  • The mnemonic DOPE—diabetes, obesity, postmaturity, and excessive weight gain—is a useful checklist for remembering conditions of potential importance. All of these conditions may play into the risk factors mentioned earlier.

Sep 8, 2022 | Posted by in OBSTETRICS | Comments Off on Shoulder Dystocia
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