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Shoulder Dystocia
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Shoulder Dystocia

(Stuck Shoulder Delivery)

Pronounced: showl-dur dis-TO-see-ah

En Español (Spanish Version)

Definition

Dystocia is a term used to describe the difficult labor and delivery of a baby. In shoulder dystocia, the baby's head can be delivered but the shoulders can't pass through the birth canal. The shoulders are too wide to fit, and become lodged behind the mother's pubic bone or the opening of the birth canal.

Typically, babies born with shoulder dystocia don’t suffer long-term complications. If complications do occur, they are usually because the baby has become stuck too long in the birth canal.

Complications to the baby include lack of oxygen, broken arm or collarbone, arm nerve damage or paralysis. Complications to the mother include tearing or bruising of the cervix, rectum, or vagina. Bruising to the bladder and hemorrhaging may also occur.

Shoulder Lodged Against Pubic Bone

Birth dystocia

© 2008 Nucleus Medical Art, Inc.

Causes

There are a variety of reasons why a baby's shoulders may become lodged during delivery, but the most common reasons for shoulder dystocia include:

  • Delivering very large babies with unusually high birth weights
    • Usually caused by diabetes or mothers who are significantly overweight
  • Mother's pelvic opening being too small to allow the baby's shoulders to fit

Narrow Pelvic Opening

Pelvis birth

© 2008 Nucleus Medical Art, Inc.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

The following factors increase the chance of a baby suffering from shoulder dystocia:

  • Mothers who are diabetic
  • Mothers who are significantly overweight
  • Mothers, often small themselves, who may have a small pelvic bone

Signs and Symptoms

The signs of shoulder dystocia become apparent during delivery. The delivery does not progress because of the baby's shoulders being lodged in the birth canal behind the pubic bone. Signs also include very large babies who are likely to have problems being delivered vaginally.

Diagnosis

Shoulder dystocia cannot actually be diagnosed until delivery. It can sometimes be predicted by determining the weight and size of the fetus and whether a vaginal delivery is safe for the mother and baby. An ultrasound maybe performed prior to labor in an attempt to determine if the baby is too large to fit safely through the birth canal during delivery.

Treatment

Your doctor will decide on the best treatment plan for you. Treatment options include:

Cesarean Delivery

A standard series of maneuvers requiring the cooperation of the mother will be attempted to deliver the baby. If these do not work, a Cesarean delivery will be performed. For babies who are at risk of shoulder dystocia because of their large size, a Cesarean delivery may be scheduled.

Prevention

Shoulder dystocia cannot be prevented. Babies who are at risk of shoulder dystocia because of large intrauterine weight can be evaluated prior to delivery with regular prenatal care and ultrasound testing.

Women with diabetes or who are very overweight should have the size of their babies estimated. Babies at risk for shoulder dystocia should have a Cesarean delivery scheduled.

RESOURCES:

American Pregnancy Association
http://www.americanpregnancy.org

Childbirth.org
http://www.childbirth.org

March of Dimes
http://www.marchofdimes.com

CANADIAN RESOURCES:

British Columbia Ministry of Health
http://bchealthguide.org

The Society of Obstetricians and Gynaecologists of Canada
http://sogc.medical.org/

References:

Cesarean section. Medline Plus Medical Encyclopedia. US National Library of Medicine website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/002911.htm. Accessed July 2, 2007.

Shoulder dystocia. Health Topics A-Z. University of Michigan Health System website. Available at: http://www.med.umich.edu/1libr/wha/wha_shldys_crs.htm. Accessed July 2, 2007.

Shoulder dystocia. Managing complications in pregnancy and childbirth: a guide for midwives and doctors. World Health Organization website. Available at: http://www.who.int/reproductive-health/impac/Symptoms/Shoulder_dystocia_S83_S85.html. Accessed July 2, 2007.



Last reviewed April 2008 by Ganson Purcell Jr., MD, FACOG, FACPE

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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