Tag Archives: shoulder dystocia

Intrapartum Interventions for Preventing Shoulder Dystocia

We had previously written about shoulder dystocia injuries caused by medical malpractice (Medical Malpractice and Shoulder Dystocia). In this article, we will explore how following the standard of care and properly managing delivery can prevent permanent injuries associated with shoulder dystocia. 

Shoulder dystocia (SD) is a serious obstetric complication that occurs during delivery when the baby’s shoulder gets stuck behind the mother’s pubic bone. It is diagnosed when the baby’s head is delivered, but the shoulders remain stuck behind the mother’s pubic bone. This can lead to severe birth trauma, including neonatal asphyxia, brachial plexus injury, and even fetal death.

It is estimated to occur in 0.3–3% of all vaginal deliveries, with higher rates in certain risk factors such as larger than average babies, diabetes, and macrosomia. As such, it is important to take precautionary measures to prevent shoulder dystocia from occurring in the first place. Intrapartum interventions, including fetal monitoring, external cephalic version, and the use of forceps and vacuum extraction, are used to reduce the risk of SD and its associated complications.

Ultrasound

Ultrasound is used to predict shoulder dystocia by measuring the size of the baby.  Babies that are bigger than normal (sometimes called macrosomia) often have a higher risk of shoulder dystocia. The doctor can also look for other signs of shoulder dystocia on the ultrasound, such as a larger than normal space between the baby’s shoulder blades. If these signs are present, there is an increased risk of shoulder dystocia and the doctor should discuss this with their patient and can take steps to reduce the risk.

Fetal Monitoring

Fetal monitoring is a non-invasive approach used to assess the baby’s well-being during labor. It can be done with either a fetal heart rate monitor or an ultrasound to detect any abnormalities in the fetal heart rate or in the presentation of the baby. Fetal monitoring can help detect signs of fetal distress that can be associated with a slow progression of labor and subsequent shoulder dystocia.

External Cephalic Version (ECV)

External cephalic version (ECV) is a procedure used to manually turn the baby in the uterus from a breech position to a cephalic (head-first) position. This can reduce the risk of SD since the baby’s head is larger than the shoulders, and the head-first presentation can make it easier for the baby to pass through the mother’s pelvis. ECV is generally only recommended for breech pregnancies, and it is not recommended for women with certain risk factors such as placenta previa or a history of uterine surgery.

Forceps and Vacuum

Extraction Forceps and vacuum extraction are two instruments used to assist in delivery. Forceps are curved blades that fit around the baby’s head, and they are used to guide the baby’s head out of the birth canal. Vacuum extraction is a procedure in which a plastic cup is attached to the baby’s head, and suction is used to help guide the baby’s head out of the birth canal. Both of these instruments can reduce the risk of SD by helping to guide the baby’s head out of the birth canal and reduce the risk of a prolonged second stage of labor.

Shoulder Dystocia and Medical Malpractice

Shoulder dystocia is a serious obstetric complication that can lead to severe birth trauma and even death if not managed properly. Intrapartum interventions, such as ultrasound, fetal monitoring, external cephalic version, and the use of forceps and vacuum extraction, are often used to reduce the risk of shoulder dystocia and its associated complications. It is important for healthcare providers to be aware of the risk factors for shoulder dystocia and to recommend the appropriate intrapartum interventions for women at risk.

Although shoulder dystocia can be difficult to predict, often serious injury can be prevented if medical providers properly manage the delivery and follow the standard of care. In some cases, injuries from shoulder dystocia are caused by medical malpractice. If a medical professional fails to provide the expected level of care, then the patient or their family may be eligible to file a medical malpractice lawsuit in Philadelphia.

James Goslee is an experienced medical malpractice, personal injury and product liability trial lawyer in Philadelphia.  James Goslee can be reached at CPR Law or on linked in at LinkedIn

References American College of Obstetricians and Gynecologists. (2018). Practice Bulletin No. 201: Shoulder dystocia. Obstetrics & Gynecology, 132(3), e112-e125 (Pub Med)

Hill M., R., Cohen, W. (2016). Shoulder Dystocia: Prediction and Management (Managing Shoulder Dystocia

Nelson K., Sartwelle, T, Electronic fetal monitoring, cerebral palsy, and caesarean section: assumptions versus evidence (Fetal Monitoring)