Abdulhafid A budher
Department of Obstetrics and Gynaecology, Tripoli Medical Centre
JMJ Vol. 1, No. 2 (November 2001): 19-22
Shoulder dystocia is a clinical problem that occurs so infrequent that doctors who are in their early training have not usually encountered it, and this complication is the most serious second stage abnormality in vertex presentation. The problem usually occurs quite unexpectedly and it should be solved in a matter of a few minutes to avoid the sever injury to the infant or even death, and usually there is no time to send for experienced assistance. Therefore, it is assistance. Therefore, it is essential for all doctors who deliver babies to be aware of this problem and know how to manage it. Shoulder dystocia results from disproportion between the bisacromial diameter and the anerioposterior diameter of the pelvic inlet. As the posterior shoulder enters the mid-pelvis, the anterior shoulder is implanted behind the symphysis and shoulders become asynclitic. 15 it is very difficult to formulate an exact definition of shoulder dystocia, due to the wide variation of the amount of difficulty experienced in delivering the impacted shoulder. In many babies it is necessary to exert some downward hard pressure to get the anterior shoulder delivered. For others, more than the usual amount of pressure is needed to deliver the shoulder and a diagnosis of shoulder dystocia is usually made.
It has been found in a series of experiment using force-sensing devices on 29 randomly selected vaginal deliveries (including two shoulder dystocia and one birth injury) that clinician-applied peak forces are typically about 47N (Newton) for routine deliveries, 69N for difficult deliveries, and 100N for a shoulder dystocia delivery. (2) therefore if properly perceived, force, force rate, and the duration of force, are objective parameters that can be used in recognizing and managing shoulder dystocia and predicting threshold of birth injury. In the case of marked shoulder dystocia, when the shoulders are impacted high in the pelvis after delivery of the foetal head which might be of with difficulty, immediate full back of the head against the perineum will lead to difficult rotation of the foetal head. In this condition, the experienced obstetrician will recognize immediately an urgent problem to deal it.
Keywords: Shoulder Dystocia, Vertex presentation