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Obstructed labor and shoulder dystocia

¹Department of Obstetrics and Gynecology, Soroka Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.

Current Opinion in Obstetrics & Gynecology

|December 1, 1995

Summary

Dystocia, or difficult labor, is a common reason for operative delivery. Preventing shoulder dystocia involves managing maternal diabetes and considering Cesarean section for macrosomic fetuses.

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Area of Science:

Obstetrics and Gynecology
Maternal-Fetal Medicine

Background:

Dystocia of labor is a leading indication for operative delivery, affecting 8-11% of first-stage vertex deliveries and at least as many second-stage deliveries.
Labor dystocia can stem from uterine activity, fetal factors, or pelvic architecture, necessitating careful assessment in abnormal labor cases.
Shoulder dystocia presents as an infrequent yet unpredictable complication for obstetricians.

Purpose of the Study:

To review the causes and management of labor dystocia, with a focus on preventing and managing shoulder dystocia.
To highlight strategies for reducing the incidence of shoulder dystocia, particularly in relation to fetal size and maternal health.

Main Methods:

Review of existing literature on labor dystocia and shoulder dystocia.
Analysis of risk factors including uterine activity, fetal size (macrosomia), and pelvic dimensions.
Discussion of preventative measures and clinical management strategies for shoulder dystocia.

Main Results:

Tight glucose control in diabetic pregnancies can decrease the incidence of macrosomic fetuses.
Cesarean delivery is recommended for diabetic women with estimated fetal weight >4250g and non-diabetic women with estimated fetal weight >4500g.
Clinical judgment is crucial for reducing shoulder dystocia rates, though rare occurrences may challenge even experienced providers.

Conclusions:

Preventative strategies, including glycemic control and appropriate Cesarean section consideration, can mitigate the risk of shoulder dystocia.
While difficult to predict, proactive management and clinical expertise are essential for addressing shoulder dystocia when it occurs.
The rarity of shoulder dystocia can limit provider experience, underscoring the need for preparedness and sound clinical judgment.

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