Snapshot: Protocol 56 - Shoulder Dystocia
AUTHORS: George A. Macones, MD, Division of Maternal-Fetal Medicine, Dell Medical School-University of Texas at Austin and Robert B. Gherman, MD, Division of Maternal-Fetal Medicine, WellSpan Health System, York, PA.
SYNOPSIS: In this protocol, Macones and Gherman reviews the pathophysiology, diagnosis, and management of shoulder dystocia. Included are descriptions of extraordinary movements and a list of documentation suggested when a shoulder dystocia is encountered.
Protocols for High-Risk Pregnancies, 7th Edition
As the authors note, shoulder dystocia is unpredictable and reported incidence varies from 0.2% to 3.0%. Risk does increase with birth weight, but up to 60% of shoulder dystocias occur in infants weighing less than 4000 g and only 3.3% of births with weights greater than 4000 g involve this complication. Episiotomy alone will not release an impacted shoulder and cutting a generous episiotomy or proctoepisiotomy should be based on clinical circumstances.
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