Shoulder dystocia is defined as a vaginal cephalic birth that requires additional manoeuvres to release the impacted shoulder after the head has been born, and routine traction employed to deliver a fetus has been unsuccessful.
An objective diagnosis of a prolonged head-to-body delivery time of more than 60 seconds has also been proposed, but these data are not routinely collected. Shoulder dystocia occurs when either the anterior or, much less commonly, the posterior fetal shoulder impacts on the maternal symphysis or sacral promontory respectively.
There can be significant perinatal morbidity and mortality associated with shoulder dystocia, even when it is managed appropriately. Maternal morbidity is increased, particularly postpartum haemorrhage (11%) and obstetric anal sphincter injury (3.8%), with their incidence remaining unchanged by the number or type of manoeuvres required to effect birth. Brachial plexus injury (BPI) is one of the most important fetal complications of shoulder dystocia, complicating 2.3–16% of such births.
The purpose of this guideline is to review the current evidence regarding associated antenatal and intrapartum risk factors and the management of shoulder dystocia. This guideline does not include primary prevention of large for gestational age fetuses associated with gestational diabetes mellitus, as this is discussed in NICE Guideline NG3 Diabetes in pregnancy: management from preconception to the postnatal period. This guideline provides guidance for skills training for the management of shoulder dystocia, but the practical manoeuvres are not described in detail as this requires practical training.
Version history
This is the third edition of this guideline. The first edition was published in 2005 under the same title and the second edition was published in 2012.
Disclosures of interest
Included in the published guideline.