Shoulder Dystocia

Publication ID Published Volume
8228 March 17, 2011 7

Abstract

Shoulder dystocia is an obstetric emergency complicating 0.3-1% of all deliveries, and can lead to permanent disability or death of the neonate, and on occasion, serious morbidity of the mother. Though frequently associated with higher birth weights, 50% of shoulder dystocias occur in normally grown neonates, making prediction of shoulder dystocia difficult. Shoulder dystocia occurs when descent of the neonate’s anterior shoulder is obstructed by the mother’s pubic symphysis and on occasion when the posterior shoulder is obstructed by the sacral promontory. Because this emergency can occur unpredictably with any pregnancy, all delivery attendants must have an understanding and a management plan for this obstetric emergency.

This course is designed to give obstetric care providers an opportunity to train and practice the hand movements required to manage a shoulder dystocia. As severe shoulder dystocia is an uncommon event, a provider may go years without a real-life experience. Safe delivery of an infant suffering a shoulder dystocia requires several crucial steps. Learners in this course will 1) appropriately identify shoulder dystocia, 2) call needed back-up support, 3) communicate the situation to the mother, 4) perform the steps to relieve the shoulder dystocia, and 5) accurately document the event.

One of the great challenges to simulation training is demonstrating the effort put toward simulating clinical care results in a measureable improvement in patient care. Shoulder dystocia simulation is one of the few models that has overcome this challenge. Simulation of shoulder dystocia reduces delivery time, improves timeliness of interventions as well the performance of the necessary maneuvers. Clinically this results in a reduction of perinatal asphyxia and neonatal-ischemic encephalopathy. The model itself is low tech and reusable, making it ideal for training programs. The significance of our work is that few if any research papers studying simulation training provide adequate information about the intervention for educators interested in applying the technology to their training program. Our curriculum provides didactic materials, including video examples on the simulator, and guidelines for administration of a simulated shoulder dystocia event as well as the necessary evaluation forms and documentation.

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Citation

Fialkow M, Benedetti T, Kim S. Shoulder dystocia. MedEdPORTAL Publications. 2011;7:8228. http://doi.org/10.15766/mep_2374-8265.8228

Educational Objectives

  1. To identify a shoulder dystocia, and recognize a need for assistance.
  2. To modify and apply new knowledge to deliveries complicated by shoulder dystocia.
  3. To formulate a mental checklist of maneuvers and appropriate help.
  4. To identify components of communication with a patient.
  5. To identify aspects of the simulation that were both successful, and need improvement.
  6. To evaluate his/her performance during the simulation event by completing a self-assessment.
  7. To document the shoulder dystocia for the medical record, recording the key maneuvers, personnel present, and outcome of the patients.
  8. To demonstrate components of communication which have demonstrated improvement in patient outcomes.

Keywords

  • Shoulder Dystocia, Parturition, Birth Complications

Prior Scholarly Dissemination

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