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Shoulder Dystocia

Impaction of the baby's shoulder in the birth canal is an obstetric emergency.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Kadın Hastalıkları ve Doğum department. Book Appointment →

What is Shoulder Dystocia?

Shoulder dystocia is the inability to deliver the shoulders with normal maneuvers after the fetal head has emerged during vaginal delivery. The incidence is approximately 0.2-3% and is higher in macrosomic babies.

Complications include brachial plexus injury (Erb's palsy), clavicle and humerus fractures, neonatal asphyxia and maternal postpartum hemorrhage. Early intervention reduces poor outcomes.

ALARMER (named maneuvers) are applied in management: McRoberts maneuver, suprapubic pressure, episiotomy extension, posterior shoulder release, Wood's screw maneuver, Zavanelli maneuver.

Symptoms

'Turtle sign' - head retraction
Inability to deliver shoulder with routine traction
Delayed delivery time
Fetal distress and bradycardia
Neonatal Erb's palsy
Clavicle fracture

Risk Factors

Fetal macrosomia (>4000 g)
Maternal gestational diabetes
Advanced maternal age and obesity
History of previous shoulder dystocia
Postmaturity
Prolonged second stage and operative vaginal delivery

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • When fetal macrosomia is suspected during labor
  • Delivery plan in known diabetic pregnancy
  • Elective cesarean evaluation if there is history of previous dystocia
  • Macrosomia estimation on prenatal ultrasound
  • When the 'turtle sign' is observed during delivery

Treatment Methods

01
McRoberts maneuver (hyperflexion)
02
Suprapubic pressure (Rubin maneuver I)
03
Rubin II or Wood maneuver
04
Posterior shoulder release
05
Acceptance of fracture or Zavanelli maneuver
06
Neonatal resuscitation and injury follow-up

Which Department to Visit?

You can visit our Kadın Hastalıkları ve Doğum department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Kadın Hastalıkları ve Doğum Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.