![]() In order to objectively define SD, Spong and colleagues ( 5) proposed defining shoulder dystocia as a ʻʻprolonged head-to-body delivery time (eg, more than 60 seconds) and/or the necessitated use of ancillary obstetric maneuversʼʼ. ![]() Typically SD is heralded by the classic “turtle sign”: after the fetal head is delivered, it retracts back tightly against the maternal perineum ( 4). SD occurs when either the anterior or, less commonly, the posterior fetal shoulder impacts on the maternal symphysis or sacral promontory ( 3). SD is defined as a delivery that requires additional obstetric manoeuvres to release the shoulders after gentle downward traction has failed. Most often an unpredictable and unpreventable obstetric emergency, Shoulder Dystocia (SD) continues to evoke terror and fear among physicians, nurse midwives and other healthcare providers ( 1, 2). The purpose of this study is to review the literature concerning the everlasting problems of SD: identification of risk factors for the early detection of delivery at high risk of SD and a systematic management of this terrifying obstetric emergency in order to avoid the subsequent health, medico-legal and economic complications. Nevertheless, even if it is appropriately managed, SD is one of the most litigated cause in obstetrics, because it is frequently associated with permanent birth-related injuries and mother complications.Īll the physicians should be prepared to manage this obstetric emergency by attending periodic training, even if SD is difficult to teach for its rare occurrence and because in clinical practice it is often handled by experienced obstetricians. When it occurs, SD is difficult to manage due to the fact that there are not univocal algorithms for its management. Even though several studies showed the existence of both major and minor risk factors that may complicate a delivery, SD remains an unpreventable and unpredictable obstetric emergency. Despite its low incidence, SD still represents a huge risk of morbidity for both the mother and fetus. Shoulder Dystocia (SD) is the nightmare of obstetricians.
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