incidence of shoulder dystocia among vaginal deliveries e Practice Bulletin Shoulder Dystocia .. these resources at –Info/Shoulder. Along with the American College of Obstetricians and Gynecologists (ACOG) practice bulletin on shoulder dystocia, guidelines from England, Canada, Australia. Request PDF on ResearchGate | On Feb 1, , Robert J Sokol and others published ACOG practice bulletin: Shoulder dystocia. Number 40, November

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This theoretical framework squares with the many reports of brachial plexus injuries from cesarean section deliveries, when there was no shoulder dystocia, and with the observation aco the turtle sign. Perform a routine “shoulder dystocia review” at or around 36 weeks gestation looking for:. You considered the possibility of shoulder dystocia.

ACOG Practice Bulletin #178: Shoulder Dystocia

Documentation Careful and complete documentation of shoulder dystocia deliveries and the response to them is vital. Below are some of the axog that any such documentation record should include:. Rouse and Owen showed that the policy of prophylactic cesarean delivery for suspected macrosomia would require several thousand cesarean deliveries and millions of dollars to avert a single permanent brachial plexus injury.

Shoulder dystocia remains—and is likely to continue to remain—an unpredictable dgstocia unpreventable obstetrical emergency. The Rubin’s approach has the added benefit of “flexing” the shoulders, bringing them closer together and thus decreasing the biacromial diameter.

This discussion should include: Conclusion Shoulder dystocia remains—and is likely to continue to remain—an unpredictable and unpreventable obstetrical emergency.

The second concern is the ever-present fear in the mind of every bullletin obstetrician that if a baby is injured during a shoulder dystocia delivery, rightly or wrongly the obstetrician will be held to be at fault in the lawsuit that will almost certainly follow. Moreover, cesarean sections in this frequently obese, often diabetic patient population are not necessarily benign procedures.

They control sensation and muscular function of the shoulder, upper arm, lower arm, wrist, and hand. Even for higher risk patients whose mothers have gestational diabetes and suspected macrosomia, unnecessary cesarean sections would have to be performed to prevent one permanent brachial plexus injury.


Maneuvers McRoberts maneuver The McRoberts maneuver Figure 2 is the most commonly used shoulder dystocia resolution maneuver.

ACOG Practice Bulletin # Shoulder Dystocia

It is not particularly important whether it is the anterior or posterior shoulder or its front or back shouldet that is pushed during rotational maneuvers. Moreover, many other textbooks and papers discuss 4, g and 4, g, respectively, as weights at which to “consider” recommending a cesarean section. The injury to C-5 to C-7 in Erb’s palsy results in paralysis or weakness of the shoulder muscles, elbow flexors, and forearm supinators.

An in utero injury?

The purpose of this document is to provide clinicians with evidence-based information regarding management of pregnancies and deliveries at risk of or complicated by shoulder dystocia. Other purported risk factors for shoulder dystocia The bottom line is this: What every clinician should know Obstetricians have two major concerns when dealing with shoulder dystocia. Unfortunately its data has been abused in the medical-legal world as setting a ceiling for force used—when, in fact, the paper only examined forces in two babies who had a shoulder dystocia and only one with a brachial plexus dyatocia that one only temporary!

Fundal pressure serves only to drive the impacted shoulder further into a nondeliverable position, and should never be employed in the context of a shoulder shoilder. Induction of labor versus expectant management in macrosomia: While cutting the nuchal cord after delivery of the head is often routine, doing so in the context of a shoulder dystocia may prove fatal.

In the Wood’s pgactice maneuver Figure 4the anterior surface of either uppr or lower fetal shoulder is pushed by the deliverer’s hand in an effort to “torque” the baby out of the vagina. The goal of this maneuver is to move the fetal shoulder away from its direct anterior-posterior orientation in the maternal pelvis into an oblique position. This article was the first to document the delivery of a baby in which: Operative Obstetrics, 2nd Edition. Family and friends observing the delivery see a relatively shoulddr labor room erupt into a frenzy of activity with voices becoming tense and multiple medical practitioners coming and going.


Use terms that convey an accurate sense of the magnitude of the force used: Assign one staff member to be a timekeeper and prwctice. Epub Jul Annals shoulded Neurology ;8: Prognosis and outcome Controversies regarding shoulder dystocia Is shoulder dystocia predictable?

Shoulder Dystocia Resources

By registering you consent to the collection and use of your information to provide the products and services you have requested from us and as described in our privacy policy and terms and conditions. While many factors have been cited as increasing the risk for shoulder dystocia, careful analysis shows that there are only four primary risk factors:. Lerner Jump to Section Shoulder dystocia 1. McRoberts Maneuver Suprapubic pressure Suprapubic pressure Figure 3 is pressure applied just above the maternal symphysis pubis to the anterior shoulder of the fetus.

Sometimes Erb’s palsy is accompanied by injury to C-4, which results in phrenic nerve damage and diaphragmatic paralysis.

Brachial plexus injuries can affect any or all of the C-5 to T-1 nerve roots. Obstetricians and society will have to make a decision as to the number of unnecessary cesarean sections it is willing to have performed in order to prevent a single case of permanent brachial plexus injury.

The brachial plexus Figure 5 is a series of nerves whose roots lie between C-5 and T Shoulder Dystocia The official American Congress of Obstetricians and Gynecologists ACOG definition of a shoulder dystocia delivery is one ahoulder requires additional obstetrical maneuvers following thefailure of gentle downward traction on the fetal head to effect delivery of the shoulders.