Uterine rupture as a cause of shoulder dystocia

Shoulder dystocia and uterine rupture are complications that rarely are related.

A 34-year-old white woman, gravida 4, para 2, therapeutic abortion 1, was admitted for labor induction. Fetal heart rate monitoring was normal until full dilation, when bradycardia developed and persisted. With the use of forceps, the vertex was delivered. Head retraction signaled the possibility of shoulder dystocia. Attempts at vaginal delivery failed, necessitating abdominal delivery. The fetal body was found anterior to the already contracted, anterolaterally ruptured uterus. An abdominally assisted vaginal delivery was accomplished.

Uterine rupture may be an unsuspected cause of shoulder dystocia.