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Tsikouras P, Kotanidou S, Nikolettos K, Kritsotaki N, Bothou A, Andreou S, Nalmpanti T, Chalkia K, Spanakis V, Peitsidis P, Iatrakis G, Nikolettos N. Shoulder Dystocia: A Comprehensive Literature Review on Diagnosis, Prevention, Complications, Prognosis, and Management. J Pers Med 2024; 14:586. [PMID: 38929807 PMCID: PMC11204412 DOI: 10.3390/jpm14060586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/15/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
The term dystocia refers to labor characterized by a slow progression with delayed rates or even pauses in the dilation of the cervix or the descent of the fetus. Dystocia describes the deviation from the limits that define a normal birth and is often used as a synonym for the term pathological birth. Shoulder dystocia, also known as the manual exit of the shoulders during vaginal delivery on cephalic presentation, is defined as the "failure of the shoulders to spontaneously traverse the pelvis after delivery of the fetal head". This means that obstetric interventions are necessary to deliver the fetus's body after the head has been delivered, as gentle traction has failed. Abnormal labor (dystocia) is expressed and represented in partograms or by the prolongation of the latent phase or by slowing and pausing in the phases of cervical dilatation and fetal descent. While partograms are helpful in visualizing the progress of labor, regular use of them has not been shown to enhance obstetric outcomes considerably, and no partogram has been shown to be superior to others in comparative trials. Dystocia can, therefore, appear in any phase of the evolution of childbirth, so it is necessary to simultaneously assess all the factors that may contribute to its abnormal evolution, that is, the forces exerted, the weight, the shape, the presentation and position of the fetus, the integrity and morphology of the pelvis, and its relation to the fetus. When this complication occurs, it can result in an increased incidence of maternal morbidity, as well as an increased incidence of neonatal morbidity and mortality. Although several risk factors are associated with shoulder dystocia, it has proven impossible to recognize individual cases of shoulder dystocia in practice before they occur during labor. Various guidelines have been published for the management of shoulder dystocia, with the primary goal of educating the obstetrician and midwife on the importance of a preplanned sequence of maneuvers, thereby reducing maternal and neonatal morbidity and mortality.
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Affiliation(s)
- Panagiotis Tsikouras
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Dragana, 681 00 Alexandroupolis, Greece; (S.K.); (K.N.); (N.K.); (S.A.); (T.N.); (K.C.); (V.S.); (N.N.)
| | - Sonia Kotanidou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Dragana, 681 00 Alexandroupolis, Greece; (S.K.); (K.N.); (N.K.); (S.A.); (T.N.); (K.C.); (V.S.); (N.N.)
| | - Konstantinos Nikolettos
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Dragana, 681 00 Alexandroupolis, Greece; (S.K.); (K.N.); (N.K.); (S.A.); (T.N.); (K.C.); (V.S.); (N.N.)
| | - Nektaria Kritsotaki
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Dragana, 681 00 Alexandroupolis, Greece; (S.K.); (K.N.); (N.K.); (S.A.); (T.N.); (K.C.); (V.S.); (N.N.)
| | - Anastasia Bothou
- Midwifery Department of Neonatology, University Hospital Alexandra, Vasilissis Sofias Ave. 80, 115 28 Athens, Greece;
| | - Sotiris Andreou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Dragana, 681 00 Alexandroupolis, Greece; (S.K.); (K.N.); (N.K.); (S.A.); (T.N.); (K.C.); (V.S.); (N.N.)
| | - Theopi Nalmpanti
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Dragana, 681 00 Alexandroupolis, Greece; (S.K.); (K.N.); (N.K.); (S.A.); (T.N.); (K.C.); (V.S.); (N.N.)
| | - Kyriaki Chalkia
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Dragana, 681 00 Alexandroupolis, Greece; (S.K.); (K.N.); (N.K.); (S.A.); (T.N.); (K.C.); (V.S.); (N.N.)
| | - Vlassios Spanakis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Dragana, 681 00 Alexandroupolis, Greece; (S.K.); (K.N.); (N.K.); (S.A.); (T.N.); (K.C.); (V.S.); (N.N.)
| | - Panagiotis Peitsidis
- Department of Obstetrics and Gynecology, Fetal Medicine Hospital Helena Venizelou, Elenas Venizelou 2, 115 21 Athens, Greece;
| | - George Iatrakis
- Department of Midwifery, University of West Attica, Agiou Spyridonos 28, 122 43 Egaleo, Greece;
| | - Nikolaos Nikolettos
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Dragana, 681 00 Alexandroupolis, Greece; (S.K.); (K.N.); (N.K.); (S.A.); (T.N.); (K.C.); (V.S.); (N.N.)
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Le Ray C, Oury JF. [Management of shoulder dystocia]. ACTA ACUST UNITED AC 2015; 44:1272-84. [PMID: 26530178 DOI: 10.1016/j.jgyn.2015.09.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 09/18/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this review is to propose recommendations on the management of shoulder dystocia. MATERIALS AND METHODS The PubMed database, the Cochrane Library and the recommendations from the foreign obstetrical societies or colleges have been consulted. RESULTS In case of shoulder dystocia, if the obstetrician is not present at delivery, he should be systematically informed as quickly as possible (professional consensus). A third person should also be called for help in order to realize McRoberts maneuver (professional consensus). The patient has to be properly installed in gynecological position (professional consensus). It is recommended not to pull excessively on the fetal head (grade C), do not perform uterine expression (grade C) and do not realize inverse rotation of the fetal head (professional consensus). McRoberts maneuver, with or without a suprapubic pressure, is simple to perform, effective and associated with low morbidity, thus, it is recommended in the first line (grade C). Regarding the maneuvers of the second line, the available data do not suggest the superiority of one maneuver in relation to another (grade C). We proposed an algorithm; however, management should be adapted to the experience of the operator. If the posterior shoulder is engaged, Wood's maneuver should be performed preferentially; if the posterior shoulder is not engaged, delivery of the posterior arm should be performed preferentially (professional consensus). Routine episiotomy is not recommended in shoulder dystocia (professional consensus). Other second intention maneuvers are described. It seems necessary to know at least two maneuvers to perform in case of shoulder dystocia unresolved by the maneuver McRoberts (professional consensus). CONCLUSION All physicians and midwives should know and perform obstetric maneuvers if needed quickly but without precipitation.
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Affiliation(s)
- C Le Ray
- Maternité Port-Royal, hôpital Cochin, Assistance publique des Hôpitaux de Paris, université Paris Descartes, 53, avenue de l'Observatoire, 75014 Paris, France; Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique, DHU risques et grossesse, université Paris Descartes, Sorbonne Paris Cité, 75014 Paris, France.
| | - J-F Oury
- Maternité de l'hôpital Robert-Debré, université Paris Diderot, Assistance publique des Hôpitaux de Paris, 75019 Paris, France
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