YU.V. ORLOV¹, R.K. GALEEV², O.I. LOMAKINA², A.A. KOROSTELEVA¹, A.V. KOSHKINA¹, A.R. SHAJHIEVA¹, L.D. AMIROVA¹

 ¹Kazan State Medical University, Kazan

²Children’s City Hospital with a Perinatal Center, Nizhnekamsk

 Contact details:

Orlov Yu.V. — PhD (medicine), Associate Professor, Head of the Accreditation and Simulation Center of the Department of Obstetrics and Gynecology named after Prof. V.S. Gruzdev

Address: 49 Butlerov St., Kazan, Russian Federation, 420012, tel.: +7 (843) 236-12-70, e-mail: scenter@kazangmu.ru

Shoulder dystocia is an unpredictable, unavoidable obstetric condition characterized by a lack of a generally accepted definition, consensus on treatment, and a wide variety of reported incidences worldwide.

The purpose of this review is to raise the awareness of obstetricians, gynecologists and residents in the basic principles of labor management for shoulder dystocia and the algorithm of actions proposed by various authors to resolve this emergency obstetric situation.

Materials and methods. An analytical review of the special literature on shoulder dystocia from various sources was carried out: conference proceedings, technical reports, journal articles, abstracts and online articles using the Medline, Google Scholar and PubMed databases.

Results. Shoulder dystocia is associated with a 1% risk of severe long-term disability or neonatal death. The relative rarity of shoulder dystocia and the lack of standardized management often means that few obstetricians actually have experience with this emergency obstetric problem. To resolve shoulder dystocia, a number of maneuvers are traditionally used, the proposed sequence of which is debatable by various authors.

Conclusion. Shoulder dystocia is a highly unpredictable obstetric emergency that requires all practitioners in the delivery room to have a detailed knowledge of the condition and how to manage it.

Key words: shoulder dystocia, obstetric emergency, obstetricians, residents, unpredictable, unpreventable.

REFERENCES

1. Zerbe M., Gamblian V. Using the NOELLE™ Birthing Simulator. Instructor and Student Guide, 2011–2013. 311 p.
2. Crofts J.F., Bartlett C., Ellis D. et al. Patient-actor perception of care: a comparison of obstetric emergency training using manikins and Patient-actor. Qual Saf Health Care, 2008, vol. 17 (1), rr. 20–24.
3. Chow G.E., Yancey M.K. Labor and Delivery: Normal and abnormal. Obstetrics and Gynecology principles for practice 1st edition. New York: McGraw-Hill, 2001. Rr. 423–458.
4. Shoulder Dystocia. RCOG Green-top Guideline No. 42. 2nd edition. Royal College of Obstetricians and Gynecologists. London, 2012. 18 p, available at: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_42.pdf (accessed on: 03.02.2022).
5. Allen R.H. On the mechanical aspects of shoulder dystocia and birth injury. Clin Obstet Gynecol, 2007, vol. 50 (3), rr. 607–623.
6. Gurewitsch E.D., Allen R.H. Epidemiology of shoulder dystocia and its associated neonatal complications. Textbook of perinatal epidemiology. Chapter: XXIII. New York: Nova Scientific Publishers, 2010. Rr. 453–498.
7. Griff J. Shoulder dystocia. Obstetrics and Gynaecology. An evidence-based text for MRCOG 1st edition. London: Arnold, 2004. Rr. 397–401.
8. Cunningham F.G., Leveno K.J., Hauth J.C. et al. Dystocia: Abnormal Labor. Willians obstetrics. 22nd edition. New York: McGraw-Hill, 2005. Rr. 495–524.
9. Spong C.Y., Beall M., Rodrigues D., Ross M.G. An objective definition of shoulder dystocia: Prolonged head-to-body delivery intervals and/or the use of ancillary obstetric maneuvers. Obstet Gynecol, 1995, vol. 86 (3), rr. 433–436.
10. Beall M.H., Spong C., McKay J., Ross M.G. Objective definition of shoulder dystocia; A prospective evaluation. Am J Obstet Gynecol, 1998, vol. 179 (4), rr. 934–937.
11. Bruner J.P., Drummond S.B., Meenan A.L., Gaskin I.M. All-fours maneuver for reducing shoulder dystocia during labor. J Reprod Med, 1998, vol. 43 (5), rr. 439–443.
12. Baskett T.F., Kalder E.A., Arulkumaran S. Operativnoe akusherstvo Manro Kerra. K stoletney godovshchine []. Moscow: Logosfera, 2010. 392 p.
13. Okeke T.C., Anyaehie B.U. Shoulder Dystocia. Annual Research & Review in Biology, 2014, vol. 4, is 14, rr. 2414–2426.
14. Klinicheskie rekomendatsii — Zatrudnennye rody (distotsiya) vsledstvie predlezhaniya plechika. Utverzhdeny Minzdravom RF 15.11.2020 [Clinical guidelines — Obstructed labor (dystocia) due to the presentation of the shoulder. Approved by the Ministry of Health of the Russian Federation on November 15, 2020], available at: https://www.dzhmao.ru/spez/klin_recom/akushGinekol/2020/KR_595_distotsiya.pdf (accessed on: 03.02.2022).
15. Gardner K. Problems in Labor, Delivery and the Postpartum Period. In: Obstetrics and gynecologic emergencies diagnosis and management. 1st edition. New York: McGraw-Hill, 2004. Rr. 311–327.
16. ACOG practice bulletin: Shoulder dystocia. Number 40, November 2002. (Replaces practice pattern number 7, October 1997). Int J Gynaecol Obstet, 2003, vol. 80 (1), rr. 87–92.
17. Flamm B.L. Shoulder dystocia and fundal pressure: A medical legal dilemma. J Health Risk Manag, 2002, vol. 22 (2), rr. 9–14.
18. Mochalova M.N., Novokshanova S.V., Mudrov V.A. Vertical delivery as a method of preventing obstetric and perinatal complications. Akusherstvo i ginekologiya, 2019, no. 5, pp. 7–13 (in Russ.).
19. Ramieri J., Iffy L. Shoulder dystocia. Operative Obstetrics. London: Taylor and Francis, 2006. Rr. 253–264.
20. Ouzounian J.G., Ouzounian J.G. R. B. Gherman Shoulder dystocia: Are historic risk factors reliable predictors? Am J Obstet Gynecol, 2005, vol. 192, rr. 1933–1935.
21. Mazouni C., Menard J.P., Porcu G. et al. Maternal morbidity associated with obstetrical maneuvers in shoulder dystocia. Eur J Obstet Gynecol Reprod Biol, 2006, vol. 129, rr. 15–18.
22. Royal College of Obstetricians and Gynecologists. Shoulder dystocia. Guideline No 45. London, 2005. 13 p.
23. Gonik B., Zhang N., Grimm M.J. Defining forces that are associated with shoulder dystocia: The use of a mathematic dynamic computer model. Am J Obstet Gynecol, 2003, vol. 188, r. 1068.
24. ACOG practice bulletin with another national guideline. Am J Perinatol, 2010, vol. 27 (2), rr. 129–136.
25. Vorontsova N.A., Studenov G.V., Sennikova Zh.V. et al. Prichiny distotsii plechikov v rodakh na primere Orenburgskogo oblastnogo perinatal’nogo tsentra [Causes of shoulder dystocia during childbirth on the example of the Orenburg Regional Perinatal Center]. Nauchnyy zhurnal Globus. Mul’tidistsiplinarnyy sbornik nauchnykh publikatsiy «Dostizheniya i problemy sovremennoy nauki». Meditsinskie nauki, 2019, iss. 8. Pp. 20–21.
26. Mochalova M.N., Mudrov V.A., Novokshanova S.V. The role of intranatal risk factors in the pathogenesis of birth trauma. Acta biomedical scientifica, 2020, no. 1, pp. 7–13 (in Russ.).
27. Kish K., Collea J.V. Malpresentation and card prolapse. Current Obstetric and Gynecologic Diagnosis and Treatment 9th ed. New York: Lange Medical Books / McGraw-Hill, 2003. Rr. 369–386.
28. Grigoryan O.R., Mikheeva R.K., Kurinova A.N. et al. Comparative analysis of the influence of risk factors on the course and outcomes of pregnancy in gestational diabetes. Problemy endokrinologii, 2021, vol. 67, no. 3, pp. 78–86 (in Russ.).
29. Ushanova F.O., Lobanova K.G., Perekhodov S.N. Gestational diabetes mellitus: features of the course and outcomes of pregnancy in real clinical practice. Meditsinskiy sovet, 2021, no. 7, pp. 184–191 (in Russ.).
30. Chabanova N.B., Shevlyukova T.P., Vasil’kova T.N. Clinical and hormonal-metabolic associations in pregnant women with gestational diabetes mellitus and fetal macrosomia. Prakticheskaya meditsina, 2018, no. 6, pp. 72–76 (in Russ.).
31. ACOG Practice Bulletin Number 22. Fetal macrosomia. Clinical management guidelines for obstetricians. Gynecologist, 2000.
32. Martin J.A., Hamilton B.E., Ventura S.J. et al. Births: Final Data for 2001. National vital statistics reports, 2002, vol. 51 (2), 103 r, available at: https://www.cdc.gov/nchs/data/nvsr/nvsr51/nvsr51_02.pdf (accessed on: 03.02.2022).
33. Lewis D.F., Raymond R.C., Perkins M.B. et al. Recurrence rate of shoulder dystocia. Am J Obstet Gynecol, 1995, vol. 172, rr. 1369–1371.
34. Arulkumaran S., Morgan G.E., Tamizian O. Obstetric emergencies. Oxford handbook of Obsterics and Gynaecology. 2nd edition. New Delhi: Oxford University Press, 2004. Rr. 385–391.
35. McFarland M., Hod M., Piper J.M. et al. Are labor abnormalities more common in shoulder dystocia? Am J obstet Gynecol, 1995, vol. 173, rr. 1211–1214.
36. Nepso Yu.R., Torosyan K.E., Novikova V.A., Khorol’skiy V.A. The role of preconception training in women with diabetes. Prakticheskaya meditsina, 2015, no. 1, pp. 56–61 (in Russ.).
37. Miftakhutdinova D.K., Teregulova L.E., Galimova I.R. Ultrasound protocol during childbirth. Prakticheskaya meditsina, 2015, no. 4-1, pp. 143–146 (in Russ.).
38. Orlov Yu.V. Obstetric «straight» Killand’s forceps, their creation, device, application features. Prakticheskaya meditsina, 2019, no. 4, pp. 24–31 (in Russ.).
39. Kreitzer M.S. A survey of central association members about the definition, management, and complications of shoulder dystocia. Obstet Gynecol, 2012, vol. 120 (4), rr. 809–814.
40. Ampilova E.A., Egamberdieva L.D., Fatkheeva L.S., Zakirova N.R. Stillbirth rate analysis in the Republic of Tatarstan in 2017 — problems and solutions. Prakticheskaya meditsina, 2018, no. 7, pp. 11–14 (in Russ.).
41. Cherepanova N.A., Zamaleeva R.S., Mal’tseva L.I., Frizina A.V. Contradictions of dubious variants of CTG in assessing the functional state of the fetus in the third trimester of pregnancy. Prakticheskaya meditsina, 2019, no. 4, pp. 37–42 (in Russ.).
42. Markova T.N., Solov’eva Ya.A., Pechenkina A.V., Gorshkova A.V. Diabetes mellitus and pregnancy: clinical cases from the practice of an endocrinologist. Lechashchiy vrach, 2020, no. 12, pp. 30–34 (in Russ.).
43. Buynenko N.V. Clinic and management of childbirth with shoulder dystocia. Meditsina i ekologiya, 2012, no. 1, pp. 7–11 (in Russ.).
44. Gorbunov N.S., Rostovtsev S.I., Samotesov P.A. et al. To the question of the structure of the brachial plexus: modern views in surgery. Sibirskoe meditsinskoe obozrenie, 2020, no. 2, pp. 13–19 (in Russ.).
45. Agranovich O.E. Cocontraction in patients with consequences of intranatal brachial plexus injury (literature review). Nervno-myshechnye bolezni, 2021, vol. 11, no. 1, pp. 12–18.
46. Gherman R.B., Ouzounian J.G., Satin A.J. et al. A comparison of shoulder dystocia associated transient and permanent brachial plexus palsies. Obstet Gynecol, 2003, vol. 102 (3), rr. 544–548.
47. Donnelly V., Forum A., Murphy J. et al. Neonatal brachial plexus palsy: an unpredictable injury. Am J Obstet Gynecol, 2002, vol. 187 (5), rr. 1209–1212.
48. Paris A.E., Greenberg J.A., Ecker J.L., McEllrath T. F. Is an episiotomy necessary with a shoulder dystocia? Am J Obstet Gynecol, 2011, vol. 205 (3), rr. 217–221.
49. Gurewitsch E.D., Donithan M., Stallings S.P. et al. Episiotomy versus fetal manipulation in managing severe shoulder dystocia: a comparison of outcomes. Am J Obstet Gynecol, 2004, vol. 191 (3), rr. 911–916.
50. Mollberg M., Wennergren M., Bager B. et al. Obstetric brachial plexus palsy: A prospective study on risk factors related to manual assistance during the second stage of labor. Acta Obstet Gynecol Scand, 2007, vol. 86 (2), rr. 198–204.
51. Chauhan S.P., Laye M. R., Lutgendorf M. et al. A Multicenter Assessment of 1,177 Cases of Shoulder Dystocia: lessons learned. Am J Perinatol, 2014, vol. 31 (5), rr. 401–406.
52. Patient safety checklist no. 6: documenting shoulder dystocia. Obstetrics & Gynecology, 2012, vol. 120, is. 2 (part 1), pp. 430–431.
53. Deering S.H., Tobler K., Cypher R.I. Improvement in documentation using an electronic checklist for shoulder dystocia deliveries. Obstet. Gynecol, 2010, vol. 116 (1), rr. 63–66.
54. Moragianni V.A., Hacker M.R., Craparo F.J. Improved overall delivery documentation following implementation of a standardized shoulder dystocia delivery. J Perinat Med, 2011, vol. 40 (1), rr. 97-100.
55. Crofts J.F., Attilakos G., Read M. et al. Shoulder dystocia training using a new birth training mannequin. BJOG, 2005, vol. 112 (7), rr. 997–999.