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Shoulder dystocia ( was episiotomy and shoulder dystocia )From: Malcolm Griffiths (malcolm@mgriff22.demon.co.uk)Thu May 1 16:13:06 1997
In message <01BC558F.7503D140@ronhelm.seanet.com>, Ronald Helm <ronhelm@ronhelm.seanet.com> writes >I think that the trues shoulder dystocia is made in retrospect only. If >the baby is delivered with only a McRoberts maneuver and some supra-pubic >direction to the anterior shoulder, then I think that was "tight >shoulders". If a baby, or Mother suffers injury, i.e. Erb's palsy, etc as >a result of the manipulation required to deliver the baby, be it Wood's, >posterior arm, clavicular fracture, Zavinelli maneuver, or in some >countries a symphysiotomy, then in retrospect THAT was a true shoulder >dystocia. God be willing this never happens to you or anyone else. I fear >shoulder dystocia more than anything in obstetrics and it really deserves >your respect. Ron > Whilst I have seen shoulder dystocias which have led to both Erb's palsy and even fetal death I don't think it's correct to classify only those difficult deliveries which result in major fetal pathology as shoulder dystocia, and regard others as "tight shoulders". Equally I don't accept the view that minimal delay in the interval between delivery of head and shoulders ( the sort of thing many of us would regard as the normal interval between contractions ! ) as being true shoulder dystocia either. My definition of shoulder dystocia is that the shoulders won't deliver by a combination of maternal effort and SAFE obstetrician or midwife downward traction. Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt Obstetrician & Gynaecologist Luton & Dunstable Hosp., LU6 2DT, UK. Tel: 01582-497459 (office) Fax: 01582-497424 01525-222849 (home) email: Malcolm@mgriff22.demon.co.uk http://www.obgyn.net/board/griffith.htm "It is dangerous to be right on a subject on which the established authorities are wrong." (Voltaire) "But sometimes it's fun :-)" (Griffiths)
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