Shoulder Dystocia - Causes, Risk Factors, Symptoms, and Treatment

Introduction

Shoulder dystocia is a childbirth complication that occurs during the delivery of the child. It occurs when the head of the fetus passes through the birth canal, but there is difficulty in passing the shoulder through the mother’s pelvic bone. Routine labor transforms normal delivery into a complex and dangerous scenario. The condition causes a delay or inability to complete the birth. This can cause complications for the delivering mother and the newborn child, making it a critical concern for obstetric care. The condition carries a risk of neonatal morbidity and fractures. In severe cases, it carries neonatal mortality. The mother is at high risk of postpartum hemorrhage and perineal trauma. There is a need for skillful interventions to manage the condition. Several risk factors can aggravate the condition. The introduction discusses shoulder dystocia, its causes, risk factors, symptoms, diagnosis, treatment, and prevention.

What Is Shoulder Dystocia?

Shoulder dystocia is a challenging condition, which occurs during childbirth. The condition occurs when the front part of the shoulder of the fetus gets stuck behind the mother's pelvic bone, causing delay or difficulty in delivering the fetus. The head of the fetus comes out from the birth canal, but there is difficulty in passing the shoulder of the fetus from the birth canal. This can cause complex birth. This can cause risky health effects for both the mother and the baby. For complex conditions, the demands of skillful intervention can safely deliver the child.

What Are the Causes of Shoulder Dystocia?

The causes of shoulder dystocia are as follows:

• Fetal Macrosomia: It is the common cause of the condition in which the birth weight of the body is very high. The large size, exceeding nine to ten pounds, increases the likelihood of the condition.

• Post-Term Pregnancy: If the gestational period is beyond 42 weeks, it can lead to the large size of the baby. It raises the condition during labor and delivery.

• Maternal Pelvic Anomalies: If the pelvic shape of the mother is unusual or the narrow shape of the pelvic region can block the smooth passage of the baby.

• Wrong Baby Positioning: If the baby is in the wrong position, there a high risk of shoulder dystocia.

• Increased Weight of the Mother: If the pregnant mother's weight is high, it can lead to shoulder dystocia.

What Are the Risk Factors of Shoulder Dystocia?

The risk factors that elevate the risk of shoulder dystocia are as follows:

• Maternal Age: Pregnant women over 35 are more likely to develop the condition.

• Maternal Diabetes: Pregnant women with pre-existing diabetes can increase the risk of having the condition.

• Prior History of Shoulder Dystocia: A mother with a previous history of shoulder dystocia raises the risk of the condition.

• Prolonged Second Stage Labor: A woman with the prolonged second stage of labor has an elevated risk of developing a condition.

• Use of Assisted Reproductive Technologies: A woman conceived through assisted reproductive technology, such as in vitro fertilization, is at high risk of shoulder dystocia.

• Previous History of Birth With Large Babies: A mother with previous births with a high birth weight is at high risk of developing the condition.

• Multiparity: A woman with multiple births or pregnancies is more likely to develop the condition.

What Are the Signs and Symptoms of Shoulder Dystocia?

The signs and symptoms of shoulder dystocia are important for timely intervention and management. The common clinical features are as follows:

• Impaction of Shoulders: The common sign is the impaction of the shoulder behind the pelvic bone when the baby passes through the birth canal. It can cause complications during childbirth.

• Turtle Sign: The head of the baby comes out from the birth canal. The impaction of the shoulder causes the back retraction of the baby's head against the perineum, resembling a turtle head.

• Failure to Labor Progress: The labor progression gets delayed and causes complications due to shoulder impaction.

• Maternal Difficulty Pushing: The mother may struggle to push the baby out.

• Swelling on Baby Scalp: There can be swelling on the scalp of the baby, which can be due to the pressure build-up on the scalp.

What Is the Diagnosis of Shoulder Dystocia?

The steps to diagnose shoulder dystocia are described below:

• Clinical Examination: The healthcare provider may conduct a physical examination during labor. The doctor may ask the pregnant mother about previous pregnancies, deliveries, medical history, and other risk factors for shoulder dystocia.

• Estimation of Fetal Weight: The estimation of fetal weight is important to diagnose the condition. An ultrasound can examine the fetal weight.

• Assessment of Delivery Interval: The healthcare provider will assess the time interval between the head and shoulder delivery. Prolonged delivery time will suggest the condition.

• Turtle Sign Observation: The sign when the baby's head retracts during childbirth indicates shoulder dystocia.

• Pushing Difficulty During Delivery: If the mother faces difficulty pushing the baby out after the head comes out, it indicates the condition.

What Is the Treatment of Shoulder Dystocia?

Treatment involves a series of techniques for dislodging the impacted shoulders. The key steps to managing shoulder dystocia are as follows:

• Call For Specialized Healthcare Professionals: During delivery complications, the healthcare provider will call for a healthcare team, including neonatologists, anesthetists, and nursing staff.

• McRoberts Maneuver: The mother's legs should be placed in a flexed position against the abdomen. This will help in dislodging the impacted shoulder.

• Suprapubic Pressure: The healthcare provider will apply the pressure above the pubic bone to move the shoulder towards the chest. This will help in delivering the child.

• Cesarean Section: The obstetrician will suggest the woman for cesarean section if the baby's size is very large.

What Are the Preventive Measures for Shoulder Dystocia?

The preventive measures for shoulder dystocia are as follows:

• Comprehensive prenatal care and assessment to check the growth and size of the fetus.

• Management of gestational diabetes.

• Encourage pregnant mothers to have a healthy diet, balanced nutrition, and regular exercise.

• Education to pregnant mothers about childbirth risks and adoption of healthy lifestyle habits.

• Monitoring fetal growth.

• Avoid optimal labor management.

• Assessment of pelvic structure.

• Involve expectant mothers in informed decision-making regarding childbirth.

• Continuous monitoring during labor.

Conclusion

In conclusion, shoulder dystocia is an emergency when the shoulder of the baby is stuck behind the mother’s pelvic bone. The condition can affect the health of the mother and the baby. So, necessary interventions are necessary to prevent complications. Certain factors, such as gestational diabetes and obesity, must be managed to prevent the development of the condition. A skilled and experienced healthcare worker can manage the condition.