page_title: Shoulder dystocia
section_title: Complications
hierarchical_section_title: Shoulder dystocia / Signs and symptoms / Complications
caption_attribution_description: English: Fracture of both clavicles as a result of shoulder dystocia
context_page_description: Shoulder dystocia is when, after vaginal delivery of the head, the baby's anterior shoulder gets caught above the mother's pubic bone. Signs include retraction of the baby's head back into the vagina, known as "turtle sign". Complications for the baby may include brachial plexus injury, or clavicle fracture. Complications for the mother may include vaginal or perineal tears, postpartum bleeding, or uterine rupture.
  Risk factors include gestational diabetes, previous history of the condition, operative vaginal delivery, obesity in the mother, an overly large baby, and epidural anesthesia. It is diagnosed when the body fails to deliver within one minute of delivery of the baby's head. It is a type of obstructed labour.
  Shoulder dystocia is an obstetric emergency. Initial efforts to release a shoulder typically include: with a woman on her back pushing the legs outward and upward, pushing on the abdomen above the pubic bone, and making a cut in the vagina. If these are not effective, efforts to manually rotate the baby's shoulders or placing the women on all fours may be tried. Shoulder dystocia occurs in approximately 0.4% to 1.4% of vaginal births.
context_section_description: One complication of shoulder dystocia is damage to the upper brachial plexus nerves. These supply the sensory and motor components of the shoulder, arm, and hands. The ventral roots (motor pathway) are most prone to injury. The cause of injury to the baby is debated, but a probable mechanism is manual stretching of the nerves, which in itself can cause injury. Excess tension may physically tear the nerve roots out from the neonatal spinal column, resulting in total dysfunction.
  Possible complications include:
  Neonatal complications:
  Klumpke paralysis
  Erb's palsy
  Hypoxia
  Death
  Cerebral palsy
  Maternal complications:
  Postpartum bleeding (11%)
  Perineal lacerations that extend into the anal sphincter
  Pubic symphysis separation
  Neuropathy of lateral femoral cutaneous nerve
  Uterine rupture
caption: Fracture of both clavicles as a result of shoulder dystocia (top) – Post healing (bottom)
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