Shoulder dystocia, a delivery complication in which the head emerges normally through the birth canal but the shoulders remain stuck in the mother's pelvis.
Shoulder dystocia is an unanticipated complication. It can prove extremely challeging for the doctor who will be concerned about the fetus compressing the umbilical cordA flexible structure that connects the fetus to the placenta during pregnancy. It carries blood, oxygen, nourishment and waste to the placenta. It is first formed during the fifth week of pregnancy and contains the yolk sac and body stalk.
Visit our comprehensive glossary for more pregnancy terms and definitions. against the mother's pelvis.
Shoulder dystocia occurs in 0.25% - 0.35% (1 in 250 to 350) deliveries.
Although it can be impossible to determine who might be at risk of shoulder dystocia, the incidence seems to be higher among mothers with diabetes. Other risk factors include short stature, abnormal pelvic anatomy and postterm pregnancy. If you experienced shoulder dystocia in a previous pregnancy or the estimated weight of the baby is greater than 9lbs (4.09kg) the risk is also increased.
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If the doctor suspects shoulder dystocia during delivery your doctor will ask you to pull your knees as close to your chest as possible. This will result in the maximum possible enlargement of the birth canalThe passage through which the baby passes during delivery from the inlet of the true pelvis to the vaginal orifice.
Visit our comprehensive glossary for more pregnancy terms and definitions. which should permit the delivery to continue.
Your doctor may need to apply gentle pressure to the area just above the pubic bone to release the shoulder or deliver an arm first. If necessary your doctor will try to free the baby by hand. An episiotomyA surgical procedure in which an incision is made in the perineum to enlarge the vaginal opening and faciliate delivery of the baby or prevent tearing of the perineum. It is closed with absorbable sutures.
There are two types of episiotomy; the medilateral, cut at 45 degrees with midline, and median cut in the midline. The former offers more room for delivery but is more painful postpartum, while the latter heals more easily, but provides less room for delivery.
Visit our comprehensive glossary for more pregnancy terms and definitions. may be necessary to provide sufficient room to place the fingers behind the shoulder and rotate it.
In rare cases it is sometimes necessary to fracture the baby's collarbone to permit delivery. If the delivery is proving extremely difficult it may be necessary for the doctor to push the baby's head back into the vagina and opt for a cesarean section.
Maternal complications include postpartum hemorrhage, episiotomyA surgical procedure in which an incision is made in the perineum to enlarge the vaginal opening and faciliate delivery of the baby or prevent tearing of the perineum. It is closed with absorbable sutures.
There are two types of episiotomy; the medilateral, cut at 45 degrees with midline, and median cut in the midline. The former offers more room for delivery but is more painful postpartum, while the latter heals more easily, but provides less room for delivery.
Visit our comprehensive glossary for more pregnancy terms and definitions. or tearing of the perineum and uterine rupture. The baby may be delivered with a fractured collarbone or arm. Depending on whether the umbilical cord was compressed the baby may experience fetal hypoxia (oxygen deficit) that could cause potential neurological damage.
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