SHOULDER DYSTOCIA

Abstract

Shoulder dystocia considered one of the most serious emergencies in obestetrics, as it is unpredictable event & associated with high incidence of morbidity & mortality to the fetus & his mother.

There is no universal definition of shoulder dystocia, but the most

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accepted definitions are ; arrest of spontaneous delivery due to impaction I of the anterior shoulder against the symphysis pubis . Another an accurate defintion depending on time w.'tich proposed that a head-to-body delivery ', time if exceeding 60 seconds shoulder dystocia is diagnosed. l

The incidence of shoulder dystocia is also variable depending on the definition used but in average it ranges from 0.15% to 1.7% of all vaginal I delivaries. • Although shoulder dystocia is unexpected & unpredictable event, there are multiple risk factors can help in diagnosis of shoulder dystocia.These risk factors may be pre-pregnancy risk factors (eg; obesity ,multiparity ,prior shoulder dystocia & diabetes-preexisting), antepartal rik factors (eg; excessive weight gain,glucose intolerance, macrosomia & postdate) intrapartal risk factors (eg; prolonged second .stage, arrest of descent). The most important risk factor are; macro.somia as the incidence of shoulder dystocia is proportional to the fetal birth-weight & many of the other risk factors for shoulder dystocia predispose to.macrosomia.

Shoulder dystociis usually associated with multiple comlications to the mother & the fetus. For the fetus it may cause high perinatal mortality rate due to asphyxia or high fetal morbidity as; brachial plexus injury, humural fracture, clavicular fracture, phrenic nerve injury & sternomastoid muscle injury. For the mother it may cause postpartum heamorrhge, which may be due to atony of the uterus, genital tract laceration or rupture uterus. Also for the mother it causes puepral infection. bladder atony or urinary fistula.

Prevention of shoulder dystocia is the cornerstone in management of shoulder dystocia which include: l- Control of diabetes mellitus 2- Glucose screening test 3- Prophylactic insulin in gestational diabetes. 4- Termination of pregnancy 5- Prediction of fetal macrosomia.