The most common injuries associated with shoulder dystocia include fractures, brachial plexus nerve damage, and birth asphyxia. Between June 2004 and October 2008, the Pennsylvania Patient Safety Authority received 316 reports involving shoulder dystocia. Neonatal injuries were identified in 124 (39%) of these reports and included fractures, brachial plexus injuries, and death. There are several antepartum and intrapartum risk factors that contribute to shoulder dystocia, such as maternal gestational diabetes, fetal macrosomia, documented anencephaly, the use of forceps or vacuum extraction, and precipitous or prolonged second stage of labor. Shoulder dystocia risk management involves identification and communication of patients at risk for shoulder dystocia before delivery, the management of shoulder dystocia when it occurs to minimize potential injury to fetus and mother, thorough documentation and treatment upon discovery of the problem, and ongoing interdisciplinary simulation drills for all obstetric personnel that include the application of external and/or internal maneuvers.
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