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SHOULDER DYSTOCIA : OBSTETRICIAN'S NIGHTMARE
1Classified Specialist (Obstetrics & Gynaecology), INHS Sanjivani, Naval Base, Kochi-682 004.
Medical Journal, Armed Forces India
|July 14, 2016
Summary
Shoulder dystocia is a rare delivery complication. Clinical prediction is challenging, but risk factors like large babies and prolonged labor exist. Neonatal complications, including brachial palsy, are common.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
Background:
- Shoulder dystocia is an infrequent but serious obstetric emergency.
- It is associated with significant neonatal morbidity.
Purpose of the Study:
- To present cases of shoulder dystocia.
- To evaluate prediction difficulties and associated risk factors.
- To assess neonatal outcomes and the efficacy of different management maneuvers.
Main Methods:
- Retrospective case series of 12 shoulder dystocia deliveries.
- Analysis of clinical profiles, risk factors, and neonatal outcomes.
- Evaluation of McRoberts maneuver and fundal pressure efficacy.
Main Results:
- Prediction based on clinical profile is difficult; high suspicion is needed for risk factors like multigravida, large fetus, and prolonged labor stages.
- High neonatal morbidity observed: 44% brachial palsy, 44% low Apgar score.
- McRoberts maneuver had a 50% success rate with no associated neonatal injuries.
- Fundal pressure without other maneuvers resulted in 100% complication rate.
Conclusions:
- Shoulder dystocia management requires a high index of suspicion and awareness of risk factors.
- McRoberts maneuver is a safe option, though not always successful.
- Fundal pressure as a standalone maneuver should be avoided due to high complication rates.
