ABSTRACT
Maternal complications involve increased post-partum blood loss and vaginal lacerations. Retrospective studies have noted an increase in obstetric anal sphincter injuries with the fetal manipulation during the shoulder dystocia, increasing with internal maneuvers. The most common major complication of shoulder dystocia is neonatal brachial plexus impairment, which occurs in 4%–40% of cases of shoulder dystocia. Shoulder dystocia is an obstetrical emergency and cannot be reliably predicted. Thus, prompt recognition and response are essential to optimizing outcomes once it develops. Obstetricians should be trained and ready to manage this complication at every delivery. An anesthesiologist should be present during cases of shoulder dystocia to ensure adequate analgesia and prompt preparation for cesarean delivery if needed. More aggressive, “heroic” maneuvers which have very high frequency of the maternal and fetal complications may be considered after repeat failure of the first- and second-line interventions.
