Shoulder dystocia

Shoulder dystocia is when, after delivery of the head, the baby's anterior shoulder gets caught above the mother's pubic bone. Signs include retraction of the baby's head back into the vagina, known as 'turtle sign'. Complications for the baby may include brachial plexus injury or clavicle fracture. Complications for the mother may include vaginal or perineal tears, postpartum bleeding, or uterine rupture.Step 1: Index and middle fingers insertion with the hand opposite the baby's faceStep 2: Baby's head slightly tilted downward with the free handStep 3: Two fingers are placed on the humerus like a splintStep 4: Baby's hand appears under the maternal pubic symphysis, allowing the anterior arm to be delivered Shoulder dystocia is when, after delivery of the head, the baby's anterior shoulder gets caught above the mother's pubic bone. Signs include retraction of the baby's head back into the vagina, known as 'turtle sign'. Complications for the baby may include brachial plexus injury or clavicle fracture. Complications for the mother may include vaginal or perineal tears, postpartum bleeding, or uterine rupture. Risk factors include gestational diabetes, previous history of the condition, operative vaginal delivery, obesity in the mother, an overly large baby, and epidural anesthesia. It is diagnosed when the body fails to deliver within one minute of delivery of the baby's head. It is a type of obstructed labour. Shoulder dystocia is an obstetric emergency. Initial efforts to release a shoulder typically include: with a woman on her back pushing the legs outward and upward, pushing on the abdomen above the pubic bone, and making a cut in the vagina. If these are not effective efforts to manually rotate the babies shoulders or placing the women on all fours may be tried. Shoulder dystocia occurs in approximately 0.4% to 1.4% of vaginal births. Death as a result of shoulder dystocia is very uncommon. One characteristic of a minority of shoulder dystocia deliveries is the turtle sign, which involves the appearance and retraction of the baby's head (analogous to a turtle withdrawing into its shell), and a red, puffy face. This occurs when the baby's shoulder is obstructed by the maternal pelvis. One complication of shoulder dystocia is damage to the upper brachial plexus nerves. These supply the sensory and motor components of the shoulder, arm and hands. The ventral roots (motor pathway) are most prone to injury. The cause of injury to the baby is debated, but a probable mechanism is manual stretching of the nerves, which in itself can cause injury. Excess tension may physically tear the nerve roots out from the neonatal spinal column, resulting in total dysfunction. About 16% of deliveries where shoulder dystocia occurs have conventional risk factors. These include diabetes, fetal macrosomia, and maternal obesity. Risk factors: