Shoulder dystocia: a study of 47 cases

Shoulder dystocia at vaginal delivery occurred in 0.2% of cases. Antenatal prediction of this complication was very difficult. In primigravidae in labour, delay late in the first stage was a warning sign; induction of labour, the use of regional analgesia, and forceps delivery for delay in the second stage of labour were associated with subsequent shoulder dystocia, although a cause-effect relationship was not established. The immediate maternal and fetal morbidity were high, nearly 30% of the babies suffering from a severe neural or bony injury. Forty-four per cent of the babies were beyond 41 weeks of gestation, and 70% weighed over 4,000 g. The avoidance of postmaturity by elective induction of labour at 41 weeks of gestation would significantly reduce the incidence of shoulder impaction at delivery.