Shoulder dystocia is when the baby’s head has been born but one of the shoulders becomes stuck behind the mother’s pelvic bone, preventing the birth of the baby’s body.
There can be significant perinatal morbidity and mortality associated with the condition. Maternal morbidity is increased, particularly the incidence of postpartum haemorrhage (11%) as well as severe perineal tears (3.8%).
Brachial plexus injury (BPI) is one of the most important neonatal complications of shoulder dystocia, complicating 2.3–16% of such deliveries. It is the third most litigated condition in the UK.
The revised Green-top Guideline on managing shoulder dystocia recognises that training can reduce preventable injury and recommends that there should be annual, multi-professional training for all maternity staff using manoeuvres demonstrated and practiced on a high fidelity mannequin.
The guidelines refer to the largest trial of simulated shoulder dystocia which found that before training, only 43% of midwives and doctors could successfully manage a severe shoulder dystocia simulation within five minutes. Three weeks after a 40 minute simulation training session, 83% of staff were able to successfully complete the delivery.
Routine traction in an axial direction can be used to diagnose shoulder dystocia state the guidelines, but downward traction on the fetal head should be avoided in the management of all births because it has been associated with increased risk of BPI.
The revised guidelines also include evidence from a recent study about the duration of shoulder dystocia and outcomes. A group from Hong Kong recently reported that in their study, there was a very low rate of hypoxic ischaemic injury if the head-to-body delivery time was less than 5 minutes.
It is important, therefore, to manage the problem as efficiently as possible to avoid hypoxic acidosis, and as carefully as possible to avoid unnecessary trauma, say the authors.
Tim Draycott, one of the guideline developers said:
“We hope this guideline will help improve the consistency of training so that we can improve outcomes for mothers and their babies.”
For more information, contact Gerald Chan firstname.lastname@example.org or call 020 7772 6446.
To view the revised guideline, please click here.