Shoulder Dystocia

doi:10.1017/CBO9780511580987.016

Chapter 14 - Shoulder Dystocia

from Part II - INTRAPARTUM AND POSTPARTUM

Published online by Cambridge University Press: 07 May 2010

John Patrick O'Grady,

Martin L. Gimovsky,

Lucy A. Bayer-Zwirello and

Kevin Giordano

James J. Nocon

Show author details

John Patrick O'Grady: Affiliation:
Tufts University, Massachusetts
James J. Nocon: Affiliation:
Associate Professor, Department of Obstetrics and Gynecology Indiana University School of Medicine Indianapolis, Indiana

Book contents

Get access

Summary

This chapter reviews and examines the best evidence available about the nature and scope of shoulder dystocia, including reasonable management options and the challenging ethical and legal aspects surrounding this common obstetric emergency. The range of injuries to the newborn following a shoulder dystocia typically include trauma to the brachial plexus or phrenic nerve, fractures of the clavicle or humerus, neonatal asphyxia, and even death. From a medicolegal perspective, any reasonable method to resolve the impacted anterior shoulder conforms to the level of care expected of the average competent physician. If the physician can articulate a reasonable basis for the clinical judgment, and that information is documented in the medical record, then the physician has the best defense against a medicolegal entanglement. Acute management of dystocia remains a major problem. Some practitioners, on encountering a shoulder dystocia, fail to approach the problem systematically and sometimes panic.

Keywords

anterior shoulder brachial plexus palsy neonatal asphyxia traumatic delivery obstetric emergency shoulder dystocia

Information

Type: Chapter
Information: Operative Obstetrics , pp. 348 - 369
DOI: https://doi.org/10.1017/CBO9780511580987.016 [Opens in a new window]
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Gross, TL, Sokol, RJ, Williams, T, Thompson, T: Shoulder dystocia: A fetal-physician risk. Am J Obstet Gynecol 1987;156:1408–1418.CrossRef Google Scholar PubMed

Nocon, JJ, McKenzie, DK, Thomas, LJ, Hansell, RS: Shoulder dystocia: An analysis of risks and obstetrical maneuvers. Am J Obstet Gynecol 1993;168:1732–1739.CrossRef Google Scholar

Allen, R, Sorab, J, Gonik, B: Risk factors for shoulder dystocia: An engineering study of clinician-applied forces. Obstet Gynecol 1991;77:352–355.Google Scholar PubMed

Christoffersson, M, Kannisto, P, Ryhdstroem, H, Stale, H, Walles, B: Shoulder dystocia and brachial plexus injury: A case-controlled study. Acta Obstet Gynecol Scand 2003;82:147–151.CrossRef Google Scholar

Dignam, WJ: Difficulties in delivery, including shoulder dystocia and malpresentations of the fetus. Clin Obstet Gynecol 1976;19:577–585.CrossRef Google Scholar PubMed

Resnik, R: Management of shoulder girdle dystocia. Clin Obstet Gynecol 1980;23:559–564.CrossRef Google Scholar PubMed

Hopwood, HG Jr: Shoulder dystocia: Fifteen years' experience in a community hospital. Am J Obstet Gynecol 1982;144:162–166.CrossRef Google Scholar

American College of Obstetricians and Gyneco- logists: Shoulder dystocia. Practice Bulletin No. 40, November 2002. Washington, DC: American College of Obstetricians and Gynecologists.

Boyd, ME, Usher, RH, McLean, FH: Fetal macrosomia—prediction, risks and proposed management. Obstet Gynecol 1983;61:715–722.Google Scholar PubMed

Cunningham, GF, MacDonald, PC, Gant, NF, Leveno, KJ, Gillstrap, LC III: Williams Obstetrics, 19th ed. Norwalk, CT: Appleton & Lange, 1993; pp. 509–514.Google Scholar

Chez, R, Carlan, S, Greenberg, S, Spellacy, W: Fractured clavicle is an unavoidable event. Am J Obstet Gynecol 1994; 171:797–798.CrossRef Google Scholar PubMed

Swaiman, KF, Wright, FS: The Practice of Pediatric Neurology, 2nd ed. St. Louis: CV Mosby, 1982; pp. 1178–1179.Google Scholar

Gilbert, WM, Nesbitt, TS, Danielsen, B: Associated factors in 1611 cases of brachial plexus injury. Obstet Gynecol 1999;93:536–540.Google Scholar PubMed

Eng, GD: Brachial plexus palsy in newborn infants. Pediatrics 1971;41:713–719.Google Scholar

Gurewitsch, ED, Johnson, E, Hamzehzadeh, S, Allen, RH: Risk factors for brachial plexus injury with and without shoulder dystocia. Am J Obstet Gynecol 2006;194:486–92.CrossRef Google Scholar PubMed

Brett, EM: Pediatric Neurology. New York: Churchill Livingstone, 1983.Google Scholar

Jennett, RJ, Tarby, TJ, Kreinick, CJ: Brachial plexus palsy: An old problem revisited. Am J Obstet Gynecol 1992:166:1673–1676.CrossRef Google Scholar

Graham, EM, Forouzan, I, Morgan, MA: A retrospective analysis of Erb's palsy cases and their relation to birth weight and trauma at delivery. J. Matern Fetal Med 1997;6:1–5.Google Scholar PubMed

American College of Obstetricians and Gyneco- logists: Fetal macrosomia. Technical Bulletin No. 159. Washington, DC: American College of Obstetricians and Gynecologists, 1991.

Tamura, RK, Sabbagha, RE, Depp, R, Dooley, SL, Socl, ML: Diabetic macrosomia: Accuracy of third-trimester ultrasound. Obstet Gynecol 1986;67:828–832.CrossRef Google Scholar PubMed

Miller JM Jr: Identification and delivery of the macrosomic infant. In: Plauché, WC, Morrison, JC, O'Sullivan, MJ (eds): Surgical Obstetrics. Philade- lphia: WB Saunders, 1992; pp. 313–323.Google Scholar

Modanlou, HD, Dorchester, WL, Thorosian, A, Freeman, RK: Macrosomia: Maternal, fetal, and neonatal implications. Obstet Gynecol 1980;55:420–424.Google Scholar PubMed

Anderson, GD, Blinder, IN, MacClermont, S, Sinclair, JC: Determinant of size at birth in a Canadian population. Am J Obstet Gynecol 1980;150:236–244.CrossRef Google Scholar

Klebanoff, MA, Mills, JL, Berendes, HW: Mother's birth weight as a predictor of macrosomia. Am J Obstet Gynecol 1985;153:253–257.CrossRef Google Scholar PubMed

Seidman, DS, Ever-Hadani P, , Gale, R: The effect of maternal weight gain in pregnancy on birth weight. Obstet Gynecol 1989;74:240–246.Google Scholar PubMed

Klebanoff, MA, Yip, R: Influence of maternal birth weight on rate of growth and duration of gestation. J Pediatr 1987;111:287–293.CrossRef Google Scholar PubMed

Spellacy, WN, Miller, S, Winegar, A, Peterson, PQ: Macrosomia – maternal characteristics and infant complications. Obstet Gynecol 1985;66:158–160. 22.Google Scholar PubMed

Elliot, JP, Garite, TJ, Freeman, RK, McQuown, DD, Patel, JM: Ultrasonic prediction of fetal macrosomia in diabetic patients. Obstet Gynecol 1982;60:159–162.Google Scholar

Hirata, GI, Medearis, AL, Horenstein, J, Bear, MB, Platt, LD: Ultrasonographic estimation of fetal weight in the clinically macrosomic fetus. Am J Obstet Gynecol 1990;162:238–242.CrossRef Google Scholar PubMed

Delpapa, EH, Mueller-Heurbach E, : Pregnancy outcome following ultrasound diagnosis of macrosomia. Obstet Gynecol 1991;78:340–343.Google Scholar PubMed

Eden, RD, Seifert, LS, Winegar, A, Spellacy, WN: Perinatal characteristics of uncomplicated postdate pregnancies. Obstet Gynecol 1987;69:296–299.Google Scholar PubMed

Lazer, S, Biale, Y, Mazor, M, Lewenthal, H, Insler, V: Complications associated with the macrosomic fetus. J Reprod Med 1986;31:501–504.Google Scholar PubMed

Ouzounian, J, Naylor, CS, Gherman, R, Kamath, M, Johnson, M, DeLeon, J, Anguiano, H: Recurrent shoulder dystocia: How high is the risk?Am J Obstet Gynecol 2001;1856:S108.CrossRef Google Scholar

Acker, DB, Sachs, BP, Friedman, EA: Risk factors for shoulder dystocia. Obstet Gynecol 1985;66:762–768.Google Scholar PubMed

Acker, DB, Sachs, BP, Friedman, EA: Risk factors for shoulder dystocia in the average-weight infant. Obstet Gynecol 1985;67:614–618.CrossRef Google Scholar

Benson, CB, Doubilet, PM, Saltzman, DH: Sonographic determination of fetal weights in diabetic pregnancies. Am J Obstet Gynecol 1987;156:441–444.CrossRef Google Scholar PubMed

Benedetti, TJ, Gabbe, SG: A complication of fetal macrosomia and prolonged second stage of labor with mid-pelvic delivery. Obstet Gynecol 1978;52:526–529.Google Scholar

Chelmow, D, Kilpatrick, SJ, Laros, RK: Maternal and neonatal outcomes after prolonged latent phase. Obstet Gynecol 1993;81:486–491.Google Scholar PubMed

Friedman, EM: Labor: Clinical Evaluation and Management. New York: Appleton-Century-Crofts, 1978.Google Scholar

Gherman, RB, Ouzounian, JG, Satin, AJ, Goodwin, TM, Phelan, JP: A comparison of shoulder dystocia-associated transient and permanent brachial plexus palsies. Obstet Gynecol 2003;102:544–548.Google Scholar PubMed

Swartz, DP: Shoulder girdle dystocia in vertex delivery – clinical study and review. Obstet Gynecol 1960; 15:194–206.Google Scholar PubMed

Williams, JW: Obstetrics, 5th ed. New York: D. Appleton & Co., 1926.Google Scholar

Sandmire, HF, DeMott, RK: Erb's palsy: Concepts of causation. Obstet Gynecol 2000;95:941–942.Google Scholar PubMed

Moir, JC, Myerscough, PR: Munro Kerr's Operative Obstetrics, 8th ed. London: Baillière-Tindall and Cassell, 1971; p. 66.Google Scholar

Gonik, B.Zhang, N, Grimm, MJ: Prediction of brachial plexus stretching during shoulder dystocia using a computer simulation model. Am J Obstet Gynecol 2003;189:1168–1172.CrossRef Google Scholar PubMed

Wechsler, IS: Ch. 24 Peripheral nerve injuries. In Clinical Neurology, 9th ed. Philadelphia: W. B. Saunders Co., 1972.Google Scholar

Gross, SJ, Shime, J, Farine, D: Shoulder dystocia: Predictors and outcomes – A five-year review. Am J Obstet Gynecol 1987;156:334–336.CrossRef Google Scholar

Baskett, TF, Allen, AC: Perinatal Implications of Shoulder Dystocia. Obstet Gynecol 1995;86:14–17.CrossRef Google Scholar PubMed

Gherman, RB, Ouzounian, JG, Goodwin, TM: Obstetrical maneuvers for shoulder dystocia and associated fetal morbidity. Am J Obstet Gynecol 1998;178: 1126–1130.CrossRef Google Scholar PubMed

Speert, H: Iconographia Gyniatrica: A Pictorial History of Gynecology and Obstetrics. Philadelphia: FA Davis, 1973.Google Scholar

Beer, E: History of extraction of the posterior arm to resolve shoulder dystocia. Obstet Gynecol Survey 2006;61(3):149–151.CrossRef Google Scholar PubMed

McCormick, CO: Pathology of Labor, the Puerperium, and the Newborn, 2nd ed. St. Louis: CV Mosby, 1947.Google Scholar

Castallo, MA, Ullery, JC: Obstetric Mechanisms and Their Management. Philadelphia: FA Davis, 1957.Google Scholar

Hibbard, LT: Shoulder dystocia. Obstet Gynecol 1969;34:424–429.Google Scholar PubMed

Gonik, B, Stringer, CA, Held, B: An alternate maneuver for management of shoulder dystocia. Am J Obstet Gynecol 1983;145:882–884.CrossRef Google Scholar PubMed

Gonik, B, Allen, R, Sorab, J: Objective evaluation of the shoulder dystocia phenomenon: Effect of maternal pelvic orientation on force reduction. Obstet Gynecol 1989;74:44–47.Google Scholar PubMed

Poggi, SH, Allen, RH, Patel, CR, Ghidini, A, Pezzullo, JC, Spong, CY: Randomized trial of McRoberts versus lithotomy positioning to decrease force that is applied to the fetus during delivery. Am J Obstet Gynecol 2006;195:1544–1549.Google Scholar

Beall, MH, Spong, CY, Ross, MG: A randomized controlled trial of prophylactic maneuvers to reduce head-to-body delivery time in patients at risk for shoulder dystocia. Obstet Gynecol 2003;102:31–35.CrossRef Google Scholar PubMed

Woods, CE: A principle of physics as applicable to shoulder delivery. Am J Obstet Gynecol 1943;45: 796–804.CrossRef Google Scholar

Rubin, A: Management of shoulder dystocia. JAMA 1964;189:835–837.CrossRef Google Scholar PubMed

Gurewitsch, ED, Kim, EJ, Yang, JH, Outland, KE, McDonald, MK, Allen, RH: Comparing McRoberts' and Rubin's maneuvers for initial management of shoulder dystocia: An objective evaluation. Am J Obstet Gynecol 2005;192:153–60.CrossRef Google Scholar PubMed

Schwartz, BC, Dixon, DM: Shoulder dystocia. Obstet Gynecol 1958;11:468–471.Google Scholar PubMed

Poggi, SH, Spong, CY, Allen, RH: Prioritizing posterior arm delivery during severe shoulder dystocia. Obstet Gynecol 2003;101:1068–1072.Google Scholar PubMed

Gurewitsch, ED, Donithan, M, Stallings, SP, Moore, PL, Agarwal, S, Allen, LM, Allen, RH: Episiotomy versus fetal manipulation in managing severe shoulder dystocia. Am J Obstet Gynecol 2004;191:911–916.CrossRef Google Scholar PubMed

Sandberg, EC: The Zavanelli maneuver extended: Progression of a revolutionary concept. Am J Obstet Gynecol 1988;158:1347–1353.CrossRef Google Scholar PubMed

Graham, JM, Blanco, JD, Weu, T, Magee, KP: The Zavanelli maneuver: A different perspective. Obstet Gynecol 1992;79:883–884.Google Scholar PubMed

O'Leary, JA, Leonetti, HB: Shoulder dystocia: Prevention and treatment. Am J Obstet Gynecol 1990; 162:5–9.CrossRef Google Scholar PubMed

McFarland, M, Hod, M, Piper, JM, Elly M-, JX, Langer, O: Are labor abnormalities more common in shoulder dystocia?Am J Obstet Gynecol 1995;173;1211–1214.CrossRef Google Scholar PubMed

Poggi, SH, Stallings, SP, Ghidini, A, Spong, CY, Deering, SH, Allen, RH: Intrapartum risk factors for permanent brachial plexus injury. Am J Obstet Gynecol 2003;189:725–729.CrossRef Google Scholar PubMed

Acker, DB: A shoulder dystocia intervention form. Obstet Gynecol 1991;78:150–151.Google Scholar PubMed

Deering, S, Poggi, S, Hodor, J, Macedonia, C, Satin, AJ: Evaluation of resident's delivery notes after a simulated shoulder dystocia. Obstet Gynecol 2004; 104:667–670.CrossRef Google Scholar

Keeton, WP, Dobbs, DD, Keeton, RE, Owen, DG: Prosser and Keeton on the Law of Torts, 5th ed. St. Paul, MN: West Publishing, 1984.Google Scholar

Dunne v. Somoano, 550 So. 2d 5 (Fla. App. 3 Dist. 1989).

Sutherland v. County of Nassau, 593 N. W. 2d 287 (1993).

James v. Woolley, 523 So. 2d 110 (Ala 1988).

Smith v. Nguyen, 855 S. W. 2d 263 (Tex App Houston [14th Dist.] 1993, writ denied).

O'Grady, JP: Modern Instrumental Delivery. Balti- more: Williams & Wilkins, 1988.Google Scholar

Reilly v. Straub, 282 N. W. 2d 688 (Iowa 1979).

Abbott v. New Rochelle Hospital Medical Center, 529 NYS 2d 352 (1988).

Minkin, MJ: A no-fault approach to shoulder dystocia. Contemporary OB/GYN 2004;49(12):48–50.Google Scholar

Accessibility standard: Unknown

Why this information is here

This section outlines the accessibility features of this content - including support for screen readers, full keyboard navigation and high-contrast display options. This may not be relevant for you.

Accessibility Information

Accessibility compliance for the PDF of this chapter is currently unknown and may be updated in the future.