Background Shoulder dystocia remains a common cause of litigation in obstetrics.
The RCOG Shoulder Dystocia Guideline (2005) recommends auditing all cases of shoulder dystocia to improve training and patient care.
Aim This retrospective cohort study reviewed maternal and fetal complications for all cases of shoulder dystocia from July 1, 2008–Dec 31, 2010 at a large University Teaching Hospital in the UK.
Method Cases were collected from the Operating Theatre, Special Care Baby Unit, Delivery Suite and Risk Management Registries.
Results There were 292 cases (∼1%) of shoulder dystocia [primigravida (n = 100), and multiparous (n = 192)]. The overall total [Group 1] (n = 292 mean birth-weight 3.979 kg ± 0.475; the Instrumental Delivery [Group 2] (n = 94) mean birth-weight 3.937 kg ± 0.486; and the Instrumental Delivery in Theatre [Group 3] (n = 28) mean birth-weight 4.036 kg ± 0.577. In group 3, a Consultant was present in theatre 19/28 (67.86%).
FETAL COMPLICATIONS SCBU Admission (n = 17) – 5.82%
Macrosomia > 4.5 kg (n = 33) – 11.30%
Erbs Palsy & Bone Fracture (n = 6) – 2.05%
Stillbirth (n = 1)
MATERNAL COMPLICATIONS Postpartum Haemorrhage >1000 mls (n = 20) – 6.85%
3rd Degree Tear (n = 22) – 7.53% & [4th degree Tear (n = 1)]
Severe Shoulder Dystocia
Delivery head-to-body interval ≥ 5 mins (n = 12) – 4.10%
Delivery Required ≥ 3 Manoeuvres (n = 34) – 11.64%
The Risk Management team had a robust proforma with standardise documentation to identify, investigate (Serious Incident Reporting) and include all shoulder dystocia cases in the monthly maternity dashboard.
All Erbs palsy/fractures cases had outpatient Paediatric and Physiotherapy followed-up.
All staff must attend mandatory training involving shoulder dystocia drills.
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