Shoulder Dystocia Complications

Shoulder dystocia occurs when one or both of the baby’s shoulders get stuck during delivery. Often, this happens either because of a too-large baby or a too-small canal. Doctors may view this before birth on ultrasound; however, it can be challenging to predict shoulder dystocia risk.

Medical professionals diagnose shoulder dystocia by observing signs such as a delay during the second stage of labor, failure of the fetal head to descend, and the need for additional obstetric maneuvers when gentle downward traction fails.

Unfortunately, shoulder dystocia can also bring with it several potential complications, including severe shoulder dystocia, which is a critical and challenging obstetric emergency requiring skilled intervention to prevent serious fetal and maternal injuries.

Contact an experienced birth injury attorney to learn more about your right to compensation, including compensation for increased medical expenses, income losses, and pain and suffering related to those complications.

Introduction

Childbirth is a complex process that can sometimes present unexpected challenges. One such challenge is shoulder dystocia, a condition that can lead to significant complications for both the mother and the baby. Understanding shoulder dystocia, its risk factors, and the maneuvers used to manage it can help in preparing for and potentially mitigating its impact.

What is Shoulder Dystocia?

Shoulder dystocia is a medical condition that can occur during childbirth, where one of the baby’s shoulders gets stuck behind the mother’s pubic bone. This condition requires emergency intervention to deliver the baby and can cause injuries to both the baby and the mother. Shoulder dystocia occurs in about 1 in every 100 vaginal births and is unpredictable and cannot be prevented. However, certain factors may increase the risk of shoulder dystocia, including a previous history of shoulder dystocia, large baby size, post-term pregnancy, multiple pregnancy, and slow labor.

Risk Factors and Prevention

While shoulder dystocia is unpredictable and cannot be prevented, certain factors may increase the risk of its occurrence. These risk factors include:

• Previous history of shoulder dystocia
• Large baby size
• Post-term pregnancy (after 42 weeks)
• Multiple pregnancy (twins or more)
• Slow labor
• Abnormal fetal position
• Abnormal fetal size
• Abnormal uterine shape or size

To reduce the risk of shoulder dystocia, it is essential to:

• Monitor fetal growth and weight during pregnancy
• Manage gestational diabetes
• Avoid excessive weight gain during pregnancy
• Avoid multiple gestations (twins or more)
• Avoid prolonged labor
• Avoid prolonged pushing during delivery
• Use the McRoberts maneuver during delivery
• Use other maneuvers to alleviate shoulder dystocia (Rubin II, Woods’ screw, suprapubic pressure, episiotomy)

Maternal Complications

In many cases, shoulder dystocia can significantly injure the mother. When the posterior shoulder becomes lodged, maneuvers like the Rubin maneuver and Woods screw maneuver are essential to facilitate rotation and delivery. Identifying potential risk factors, such as maternal diabetes, previous shoulder dystocia, and fetal macrosomia, is crucial in understanding and managing maternal complications due to shoulder dystocia.

Postpartum Hemorrhage

Sometimes, shoulder dystocia can increase the amount of maternal bleeding following childbirth. Recurrent shoulder dystocia is a concern, as the estimated risk of recurrence is higher in women with previous shoulder dystocia and certain maternal conditions. Women may have a greater risk of postpartum hemorrhage following shoulder dystocia during birth.

Severe Tearing

As many as 9 out of 10 women experience some tearing during childbirth, and many will experience enough tearing to need stitches. However, shoulder dystocia can lead to a much higher risk of severe tearing and longer-term complications. The posterior fetal shoulder can become impacted during vaginal delivery, leading to severe tearing. Severe tearing can cause more pain postpartum and may increase the risk of pain with intercourse in the future.

Pubic Bone Separation

The space between the pubic bones naturally widens during pregnancy to prepare for delivery. Some women, however, can end up with increased separation that lingers after childbirth. Those symptoms can often result in extreme maternal pain and disability.

Women may require ongoing bed rest or, in some cases, surgery to improve outcomes while healing from pubic bone separation. Patients may also have a higher risk of other types of complications due to that pubic bone separation during delivery. Shoulder dystocia increases the odds that the woman will suffer from pubic bone separation following delivery.

Uterine Rupture

Sometimes, women may suffer uterine rupture due to shoulder dystocia. Uterine rupture means that the uterus tears during the delivery process. It can lead to extreme postpartum bleeding and a risk of death if not treated properly.

Child Complications

The baby can also have significant complications related to shoulder dystocia during the delivery process, particularly when the fetal shoulders become impacted behind the pubic symphysis or sacral promontory.

Brachial plexus injuries are a common concern, with varying types and potential outcomes. These injuries can range from transient to permanent neurologic damage, impacting both maternal and neonatal prognosis.

It is crucial to avoid maneuvers such as fundal pressure, excessive lateral traction, head rotation beyond 90°, and repeated attempts at traction to reduce the risk of brachial plexus injury. Early use of fetal maneuvers in the management of shoulder dystocia deliveries is essential to minimize this risk.

Fractures

In many cases, fractures can result when a baby’s shoulders get stuck during delivery. Careful manipulation of the fetal chest is crucial during obstetric maneuvers to avoid birth injury. Fractures can occur in the collarbone or upper arm bone. Broken bones generally heal fairly well after delivery but can cause long-term complications if the infant does not receive proper care for those injuries. Fractures can also make it more difficult for families to care for their babies after birth.

Brachial Plexus Palsy

Brachial plexus palsy occurs when the brachial plexus nerves get damaged during delivery, which may arise when the shoulders get trapped and pinched during the delivery process. Reducing shoulder dystocia through various obstetric maneuvers, such as the all-fours maneuver, can help manage and potentially reduce the incidence of this complication. The brachial plexus nerves carry feeling in the arm, hand, and shoulder. Furthermore, they help guide movement.

Sometimes, infants who have suffered damage to the brachial plexus nerve during delivery will suffer paralysis and weakness on the impacted side. Most of the time, infants will recover fully from brachial plexus palsy.

Sometimes, however, children may have ongoing weakness on the affected side. Prompt medical treatment can help increase the odds of making a full recovery. Sometimes, infants may require surgery to restore full function.

Umbilical Cord Compression

Depending on the infant’s position, when the shoulders get stuck during vaginal delivery, it can cause compression of the umbilical cord. When flattened, the umbilical cord cannot properly transmit oxygen and blood to the baby.

In extreme cases, umbilical cord compression can cause brain damage or death in the infant. Properly monitoring an infant’s heart rate during delivery can make it easier for doctors to determine whether the infant may have a high risk of suffering umbilical cord compression during delivery. Doctors may need to react quickly if they notice any changes in the infant’s heart rate.

Horner Syndrome

Horner syndrome occurs relatively rarely but can result from complications related to shoulder dystocia during delivery. Horner syndrome causes decreased pupil size and a drooping eyelid on one side of the face. It can also cause one pupil to dilate, or open, more slowly in dim light or may result in a sunken appearance on the affected side of the body.

Horner syndrome most often results from nerve damage caused during delivery. It does not have a known treatment. However, as the affected area heals, the symptoms of Horner syndrome may naturally clear up over time.

Delivery Maneuvers

McRoberts Maneuver

The McRoberts maneuver is a common technique used to alleviate shoulder dystocia. It involves hyperflexing the mother’s thighs against her abdomen, which helps to widen the pelvic outlet and facilitate the delivery of the baby’s shoulders. The McRoberts maneuver is often used in conjunction with suprapubic pressure, which involves applying pressure to the mother’s abdomen to help rotate the anterior shoulder.

Other delivery maneuvers that may be used to manage shoulder dystocia include:

• Rubin II maneuver: involves inserting a hand into the vagina to rotate the shoulder inward
• Woods’ screw maneuver: involves rotating the fetal trunk to help adduct the shoulders
• Posterior arm delivery: involves delivering the posterior arm first
• Shoulder shrug maneuver: involves rotating the head and shoulders as a unit
• Suprapubic pressure: involves applying pressure to the mother’s abdomen to help rotate the anterior shoulder

It is essential to note that these maneuvers should only be performed by trained healthcare professionals and in a controlled environment.

Can You Get Compensation for Shoulder Dystocia Complications?

Doctors may note several warning signs that shoulder dystocia may occur. Shoulder dystocia can happen during any delivery, even when the doctor and staff take the proper precautions. It is important to utilize various delivery maneuvers and form an obstetric rapid response team to manage shoulder dystocia effectively.

However, it has a greater chance of occurring under several circumstances.

• Increased fetal size. Often, doctors can observe fetal size via ultrasound. While that measurement tool may not prove entirely accurate, it can offer doctors a better idea of the baby’s likely size and help doctors make recommendations accordingly.
• Maternal pelvis size. When a woman has a known small pelvis, which doctors may note during ultrasounds or by exam, it could increase the risk of shoulder dystocia.
• Position during delivery. A woman who ends up stuck in a position that does not allow the pelvis to widen properly may have a greater risk of delivery that ends in shoulder dystocia. Often, doctors will require women to deliver in positions that do not fit their anatomy due to greater convenience for the doctor.

There are a wide range of risk factors for shoulder dystocia, including fetal macrosomia, maternal diabetes, and maternal obesity.

If shoulder dystocia, and the associated complications, occur as a result of a doctor’s negligent actions, you may have the right to compensation for those damages. According to studies published in j obstet gynecol, understanding the clinical implications and management strategies for shoulder dystocia is crucial for improving patient outcomes.

Contact the Chicago Medical Malpractice Lawyers for a free case evaluation or to learn more about your rights.