In the past, thanks to good maternal reproductive health care, obstetric complications have been partially controlled. However, it is not impossible, complications such as postpartum haemorrhage, coagulation, coagulopathy, HELLP syndrome, uterine atony … still many times make the doctor panic.
However, there is an obstetric complication that women or even those who regularly monitor health information are less likely to hear that it is difficult to have a shoulder. This accident is also considered the most scary and tragic obstetrical product.
Shoulder clutter occurs when the head of the fetus has passed through the vagina but the baby’s shoulder is still stuck in the mother’s pelvis. This is a rather dangerous obstetric emergency, if not handled promptly, it can cause many risks for both mother and child. In case it is not handled properly, it will leave serious consequences for children.
The classic risk factor of labor difficulties due to the role of a large fetus, especially in pregnancy with gestational diabetes is a higher risk of shoulder clogging. In gestational diabetes, the shoulder is very large compared to the head, so shoulder jams can occur even in the case of pregnancy is not too big. At that time, the head of the fetus can pass through the small frame easily, but the shoulder will not be able to overcome the pelvic journey, leading to shoulder dystocia.
The consequences of shoulder jams cause the fetus and mother
Neonatal mortality is high due to asphyxia and cerebral palsy injury.
As mentioned above, reincarnation has been withdrawn and death has been partially withdrawn, so the longer the time, the more seriously it affects the exchange of each other in the fetus.
In addition, the attempt to pull the fetus by placing a force on the head of the fetus, stretching the cervical spine will lead the fetus to face brain damage, healing the survival centers. Due to these reasons, postnatal mortality significantly increased in shoulder dystocia.
Besides, damage to the shoulder, arm and hand nerve plexus, can cause vibration or paralysis of these parts. Often the above symptoms disappear when the baby is 6-12 months old.
Lack of oxygen to the brain. In the case of severe hypoxia (often rare), children may have brain damage even death.
Serious hemorrhage after birth
Tearing of the uterus, vagina, cervix or rectum
Handling shoulder jams:
Call the person who supports the obstetrician, resuscitate the birth and anesthesia
Empty the bladder, gently pull the fetus
Extending the perineum
MC Roberts Procedure: An extra person on the pubic bone, the birth guard pulls the fetus with moderate traction. After this procedure, most cases of shoulder dystocia were successfully resolved.
In the above case, if you fail, turn the shoulder back into the front shoulder, lower the arm, and shoulder the back. The purpose of the procedure is to turn a high-shouldered shoulder into a back shoulder, taking advantage of the open space before the procedure to do the trick 6. If the above tips fail, the risk of fetal death is very high, the applicable methods are now: fracture of the collarbone, surgery of the pubic joint or pushing the fetus back into the womb and caesarean section.
Subjects who are at risk of shoulder junction at birth
A pregnant woman is at high risk of getting a fetal shoulder stuck at birth if:
The fetus is too large (but in most cases the shoulder is stuck at birth, the baby has normal weight)
Mother has diabetes
Mother is obese
Late birth after the expected date of birth
There was a history of being stuck in the shoulder when giving birth to a previous child
The mother is stimulated to give birth
The mother was given an epidural anesthesia at birth.
Mothers give birth often but use support tools (eg doctors use tools such as tweezers or vacuums to take children out through the vagina)
However, medical experts recommend shoulder dystocia can occur in any person even if the mother does not have the risk factors mentioned above.