Complications and management of shoulder dystocia, including various maneuvers involved, and further details.
Shoulder dystocia, a rare but potentially serious complication during vaginal delivery, requires immediate attention and specific management techniques. This medical emergency affects 0.5% to 1% of vaginal deliveries, and if the baby's shoulders do not emerge within a minute after the head, it is considered shoulder dystocia.
In the initial management of shoulder dystocia, healthcare professionals employ a series of emergency maneuvers to free the impacted shoulder. The McRoberts maneuver, which involves hyperflexing the mother's legs to widen the pelvis, and applying suprapubic pressure to dislodge the baby's shoulder from behind the pubic bone are two common techniques used[1][2].
If these methods fail, internal maneuvers such as rotating the baby's shoulders or repositioning them for easier delivery may be employed[2][3]. In rare or severe cases, more invasive interventions like intentional clavicle fracture (to reduce shoulder width) may be considered as a last resort, although this is generally avoided if possible[4]. If vaginal delivery is not feasible due to shoulder dystocia risk, a cesarean section may be recommended[3].
After a successful delivery, follow-up care often includes monitoring and treating any nerve injuries, such as brachial plexus damage (e.g., Erb’s palsy), with physical therapy, occupational therapy, and occasionally surgery if there is significant motor impairment[5]. It is crucial to address these injuries promptly to support recovery.
Common treatment options for shoulder dystocia during childbirth: - McRoberts maneuver (maternal leg hyperflexion) - Suprapubic pressure - Rotational/internal maneuvers to free the shoulder - Last resort: intentional clavicle fracture - Cesarean delivery if necessary
Post-delivery treatment addresses possible nerve injuries with therapy or surgery to support recovery[1][3][5]. Humerus fracture affects 1% to 4.2% of infants with shoulder dystocia.
It is essential to note that infants with shoulder dystocia can experience complications if delivery is delayed. The most common complication is a brachial plexus injury, which affects about 75% of infants with shoulder dystocia. Death affects 0.35% of infants with shoulder dystocia, and hypoxic brain injury affects about 0.3%[6].
Early and prompt action by a trained delivery team is critical to minimize complications for both mother and baby[1][2]. A 2017 study found that specific protocols for shoulder dystocia enabled delivery in less than 3 minutes in 99% of cases[7].
- Parents expecting a baby should be aware of the risk of shoulder dystocia, a rare but potentially serious complication during vaginal delivery.
- In cases of shoulder dystocia, healthcare professionals may employ a range of medical-conditions treating techniques to ensure a safe delivery.
- Chronic diseases and certain pre-existing medical-conditions in the mother could increase the risk of shoulder dystocia, making it essential to discuss these matters with a healthcare provider beforehand.
- If shoulder dystocia occurs, healthcare professionals might use science-backed maneuvers such as the McRoberts maneuver, suprapubic pressure, rotational/internal maneuvers, or even invasive interventions like intentional clavicle fracture, when necessary.
- Post-delivery, womens-health and mens-health specialists may monitor the infant for skin-care related issues or potential long-term health-and-wellness consequences, such as cardiovascular-health concerns or chronic-diseases.
- Mental-health support might be crucial for parents who experience complications during childbirth, some of whom may require assistance in coping with the emotional strains that arise due to shoulder dystocia-related stressors.
