Severe shoulder dystocia with a small-for-gestational-age infant: A case report

Research output: Contribution to journalArticle

Abstract

Background: Severe shoulder dystocia is disproportionately associated with large-for-gestational-age infants. Case: A nulliparous patient at 38 weeks' gestation had an uncomplicated antenatal course. Clinical pelvimetry revealed an acute-angle pubic arch but otherwise normal diameters, conjugate and sacral concavity. Prepregnancy BMI was 20.8 and she had had a 14-pound (6.4 kg) weight gain. She presented in labor and, with oxytocin augmentation, progressed to full dilation over 6 hours, followed by an 18-minute second stage. Severe shoulder dystocia was encountered, necessitating multiple maneuvers, and was resolved after 2 minutes with delivery of the posterior arm. The healthy infant weighed 2,289 g (<5th percentile) and exhibited only transient shoulder weakness, which resolved completely within 1 hour of life. With informed consent, CT pelvimetry was performed within 24 hours postpartum for investigative purposes, revealing small pelvic inlet and at-threshold interischial diameter. Conclusion: Geometric analysis reveals that borderline adequate pelvimetry likely played a significant role in severe shoulder dystocia etiology, even with a smallfor- gestational-age infant. We alert obstetric providers to the possibility of severe shoulder dystocia in patients with borderline adequate pelves on clinical examination, even when estimated fetal weight makes cephalopelvic disproportion unlikely.

Original languageEnglish (US)
Pages (from-to)178-180
Number of pages3
JournalJournal of Reproductive Medicine for the Obstetrician and Gynecologist
Volume56
Issue number3
StatePublished - Jun 2011

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Small for Gestational Age Infant
Dystocia
Pelvimetry
Gestational Age
Cephalopelvic Disproportion
Fetal Weight
Oxytocin
Informed Consent
Pelvis
Postpartum Period
Obstetrics
Weight Gain
Dilatation
Arm
Pregnancy

Keywords

  • Dystocia
  • Fetopelvic disproportion
  • Pelvimetry
  • Risk factors

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Reproductive Medicine

Cite this

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title = "Severe shoulder dystocia with a small-for-gestational-age infant: A case report",
abstract = "Background: Severe shoulder dystocia is disproportionately associated with large-for-gestational-age infants. Case: A nulliparous patient at 38 weeks' gestation had an uncomplicated antenatal course. Clinical pelvimetry revealed an acute-angle pubic arch but otherwise normal diameters, conjugate and sacral concavity. Prepregnancy BMI was 20.8 and she had had a 14-pound (6.4 kg) weight gain. She presented in labor and, with oxytocin augmentation, progressed to full dilation over 6 hours, followed by an 18-minute second stage. Severe shoulder dystocia was encountered, necessitating multiple maneuvers, and was resolved after 2 minutes with delivery of the posterior arm. The healthy infant weighed 2,289 g (<5th percentile) and exhibited only transient shoulder weakness, which resolved completely within 1 hour of life. With informed consent, CT pelvimetry was performed within 24 hours postpartum for investigative purposes, revealing small pelvic inlet and at-threshold interischial diameter. Conclusion: Geometric analysis reveals that borderline adequate pelvimetry likely played a significant role in severe shoulder dystocia etiology, even with a smallfor- gestational-age infant. We alert obstetric providers to the possibility of severe shoulder dystocia in patients with borderline adequate pelves on clinical examination, even when estimated fetal weight makes cephalopelvic disproportion unlikely.",
keywords = "Dystocia, Fetopelvic disproportion, Pelvimetry, Risk factors",
author = "Ruis, {Kristy A.} and Robert Allen and {Gurewitsch Allen}, Edith",
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N2 - Background: Severe shoulder dystocia is disproportionately associated with large-for-gestational-age infants. Case: A nulliparous patient at 38 weeks' gestation had an uncomplicated antenatal course. Clinical pelvimetry revealed an acute-angle pubic arch but otherwise normal diameters, conjugate and sacral concavity. Prepregnancy BMI was 20.8 and she had had a 14-pound (6.4 kg) weight gain. She presented in labor and, with oxytocin augmentation, progressed to full dilation over 6 hours, followed by an 18-minute second stage. Severe shoulder dystocia was encountered, necessitating multiple maneuvers, and was resolved after 2 minutes with delivery of the posterior arm. The healthy infant weighed 2,289 g (<5th percentile) and exhibited only transient shoulder weakness, which resolved completely within 1 hour of life. With informed consent, CT pelvimetry was performed within 24 hours postpartum for investigative purposes, revealing small pelvic inlet and at-threshold interischial diameter. Conclusion: Geometric analysis reveals that borderline adequate pelvimetry likely played a significant role in severe shoulder dystocia etiology, even with a smallfor- gestational-age infant. We alert obstetric providers to the possibility of severe shoulder dystocia in patients with borderline adequate pelves on clinical examination, even when estimated fetal weight makes cephalopelvic disproportion unlikely.

AB - Background: Severe shoulder dystocia is disproportionately associated with large-for-gestational-age infants. Case: A nulliparous patient at 38 weeks' gestation had an uncomplicated antenatal course. Clinical pelvimetry revealed an acute-angle pubic arch but otherwise normal diameters, conjugate and sacral concavity. Prepregnancy BMI was 20.8 and she had had a 14-pound (6.4 kg) weight gain. She presented in labor and, with oxytocin augmentation, progressed to full dilation over 6 hours, followed by an 18-minute second stage. Severe shoulder dystocia was encountered, necessitating multiple maneuvers, and was resolved after 2 minutes with delivery of the posterior arm. The healthy infant weighed 2,289 g (<5th percentile) and exhibited only transient shoulder weakness, which resolved completely within 1 hour of life. With informed consent, CT pelvimetry was performed within 24 hours postpartum for investigative purposes, revealing small pelvic inlet and at-threshold interischial diameter. Conclusion: Geometric analysis reveals that borderline adequate pelvimetry likely played a significant role in severe shoulder dystocia etiology, even with a smallfor- gestational-age infant. We alert obstetric providers to the possibility of severe shoulder dystocia in patients with borderline adequate pelves on clinical examination, even when estimated fetal weight makes cephalopelvic disproportion unlikely.

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