Shoulder Dystocia

  • Tim DraycottEmail author
  • Jo Crofts


Shoulder dystocia is an obstetric emergency with implications for both mother and baby. For the mother there is both the physical and psychological trauma of the delivery and for the baby the risk of obstetric brachial plexus injury, hypoxic damage and even death. Shoulder dystocia remains a highly litigious area in obstetrics even when cases are appropriately managed. Because it is difficult to predict antenatally, the focus for management is around adequate training particularly using simulation drills. Accurate documentation is also a key factor particularly with respect to the anterior shoulder. This chapter deals with the importance of following national guidance regarding mode of delivery and highlights the importance of the accurate documentation of the event.


Shoulder dystocia Obstetric brachial plexus injury Anterior shoulder Operative vaginal delivery Fetal macrosomia Litigation 


  1. 1.
    Crofts J, Fox R, Draycott T. Shoulder dystocia. In: RCOG, editor. Greentop guidelines. London: RCOG; 2012. p. 1–18.Google Scholar
  2. 2.
    Chauhan S, Blackwell SB, Ananth CV. Neonatal brachial plexus palsy: incidence, prevalence, and temporal trends. Semin Perinatol. 2014;38(4):210–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Angelini DJ, Greenwald L. Closed claims analysis of 65 medical malpractice cases involving nurse-midwives. J Midwifery Womens Health. 2005;50(6):454–60.CrossRefPubMedGoogle Scholar
  4. 4.
    Henary BY, et al. Epidemiology of medico-legal litigations and related medical errors in Central and Northern Saudi Arabia. A retrospective prevalence study. Saudi Med J. 2012;33(7):768–75.PubMedGoogle Scholar
  5. 5.
    NHS Litigation Authority. Ten years of maternity claims: an analysis of NHS litigation authority data. London: NHS Litigation Authority; 2012.Google Scholar
  6. 6.
    Fox R, Yelland A, Draycott T. Analysis of legal claims--informing litigation systems and quality improvement. BJOG. 2014;121(1):6–10.CrossRefPubMedGoogle Scholar
  7. 7.
    Crofts J, et al. In: RCOG, editor. RCOG Greentop Guideline 42: shoulder dystocia. London: RCOG; 2012.Google Scholar
  8. 8.
    Draycott T, Fox R, Montague I. In: RCOG, editor. RCOG Greentop Guideline 42: shoulder dystocia. London: RCOG; 2005. p. 1–13.Google Scholar
  9. 9.
    Draycott T, et al. A template for reviewing the strength of evidence for obstetric brachial plexus injury in clinical negligence claims. Clin Risk. 2008;14(3):96–100.CrossRefGoogle Scholar
  10. 10.
    Draycott TJ, et al. Improving neonatal outcome through practical shoulder dystocia training. Obstet Gynecol. 2008;112(1):14–20.CrossRefPubMedGoogle Scholar
  11. 11.
    Crofts JF, et al. Observations from 450 shoulder dystocia simulations: lessons for skills training. Obstet Gynecol. 2008;112(4):906–12.CrossRefPubMedGoogle Scholar
  12. 12.
    Leung T, et al. Comparison of perinatal outcomes of shoulder dystocia alleviated by different type and sequence of manoeuvres: a retrospective review. BJOG. 2011;118(8):985–90.CrossRefPubMedGoogle Scholar
  13. 13.
    Crofts JF, et al. Prevention of brachial plexus injury-12 years of shoulder dystocia training: an interrupted time-series study. BJOG. 2016;123(1):111–8.CrossRefPubMedGoogle Scholar
  14. 14.
    RCOG. Choosing to have a caesarean section. London: RCOG; 2015. p. 1–6.Google Scholar
  15. 15.
    Boulvain M, et al. Induction of labour versus expectant management for large-for-date fetuses: a randomised controlled trial. Lancet. 2015;385(9987):2600–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Gherman R. A guest editorial: new insights to shoulder dystocia and brachial plexus palsy. Obstet Gynecol Surv. 2003;58(1):1–2.CrossRefPubMedGoogle Scholar
  17. 17.
    Noble A. Brachial plexus injuries and shoulder dystocia: medico-legal commentary and implications. J Obstet Gynaecol. 2005;25(2):105–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Sandmire HF, DeMott RK. Erb’s palsy: concepts of causation. Obstet Gynecol. 2000;95(6 Pt 1):941–2.PubMedGoogle Scholar
  19. 19.
    Mollberg M, 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;86(2):198–204.CrossRefPubMedGoogle Scholar
  20. 20.
    Beall MH, Spong CY, Ross MG. A randomized controlled trial of prophylactic maneuvers to reduce head-to-body delivery time in patients at risk for shoulder dystocia. Obstet Gynecol. 2003;102(1):31–5.PubMedGoogle Scholar
  21. 21.
    Gherman RB, et al. Neonatal brachial plexus injury. Obstet Gynecol. 2014;123.Google Scholar
  22. 22.
    Metaizeau J, Gayet C, Plenat F. Les lesions obstetricales du plexus brachial. Chir Pediatr. 1979;20(3):159–63.PubMedGoogle Scholar
  23. 23.
    Leung TY, Chung TK. Severe chronic morbidity following childbirth. Best Pract Res Clin Obstet Gynaecol. 2009;23(3):401–23.CrossRefPubMedGoogle Scholar
  24. 24.
    Mollberg M, et al. Comparison in obstetric management on infants with transient and persistent obstetric brachial plexus palsy. J Child Neurol. 2008;23(12):1424–32.CrossRefPubMedGoogle Scholar
  25. 25.
    Poggi SH, et al. Intrapartum risk factors for permanent brachial plexus injury. Am J Obstet Gynecol. 2003;189(3):725–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Leung TY, et al. Head-to-body delivery interval and risk of fetal acidosis and hypoxic ischaemic encephalopathy in shoulder dystocia: a retrospective review. BJOG. 2011;118(4):474–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and GynaecologySouthmead Hospital, North Bristol NHS TrustBristolUK
  2. 2.Academic Women’s Health Unit, School of Clinical SciencesUniversity of BristolBristolUK

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