Can Shoulder Dystocia Be Prevented?
I. Blickstein Dept. of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Hadassah-Hebrew University School of Medicine, Israel Introduction While shoulder dystocia (SD) is unanimously regarded as the Nightmare of the Accoucheur, it simply denotes difficult delivery of the shoulders following the delivery of the head. Fetal morbidity, in particular brachial plexus injury (BPI), was considered avoidable if SD could be prevented. Important lines of evidence that suggest that BPI is not associated with SD lead to a plausible antenatal aetiology for this morbidity. Thus, avoiding SD will not avoid BPI. The Options (1) All babies delivered by CS. This theoretical option will eliminate all SD cases since SD occurs only in vaginal birth. However, large case studies have shown that 3% of BPI occur in babies delivered by CS. Thus CS will avoid SD but will not eliminate BPI. (2) CS for at risk babies. Since CS for all babies is not a practical solution, a roster of risk factors has been
