Shoulder dystocia is an unpredictable obstetric complication with the incidence of 0.15% to 2%. An increase in the incidence of
shoulder dystocia has been recorded over the last 20 years, probably just because it has now been regularly registered at maternity wards as an obstetric complication. The risk factors for
shoulder dystocia include
fetal macrosomia,
fetal malformations and
tumors, maternal adiposity, excessive
weight gain during pregnancy,
diabetes mellitus, pathologic pelvis, multiparity, short maternal stature, advanced maternal age, postterm pregnancy, so-called midforceps delivery or vacuum extraction, prolonged delivery stage II,
oxytocin labor induction, premature fetal expression according to Kristeller, and previous
shoulder dystocia in macrosomatic children. The sequels of
shoulder dystocia and obstetric maneuvers for incarcerated shoulder release include clavicular fracture, brachial plexus lesions, sternocleidomastoid muscle distension with or without
hematoma,
diaphragmatic paralysis,
Horner's syndrome, peripartal
asphyxia and consequential cerebral lesions (
cerebral palsy), and peripartal death. Maternal complications due to
shoulder dystocia are postpartal
hemorrhage, cervical and vaginal
lacerations, frequent
infections during the puerperium, symphysiolysis and
rupture of the uterus, and secondary
cesarean section with related complications due to unsuccessful obstetric procedures or as continuation of Zavanelli's maneuver. McRoberts' maneuver (or Gaskin maneuver) is recommended as the initial procedure for shoulder release in case of
shoulder dystocia. If it fails, other obstetric procedures such as Resnik's suprapubic pressure and Woods' grip with posteriorly placed arm release should be used, always with gross lateral
episiotomy. The performance of all these obstetric procedures requires skilfull and highly experienced obstetrician and obstetric team as a whole.