Schulterdystokie – Risikofaktoren und Hinweiszeichen

Abstract

Shoulder dystocia represents a severe obstetric emergency with the risk of injury to the newborn even in cases with adequate reactions by the obstetrician. Therefore, the potential benefit of early diagnosis is obvious. Using the cases of 53 newborns out of 14,193 births within 11 years we have analysed the association between a BIP-thoracic diameter difference greater 14 mm and the obstetric manoeuvres for foetal birth. With classic foetal ultrasound biometry, most of the birth weights near or beyond term were underestimated. In the group with a BIP-thoracic diameter difference greater than 14 mm, all the obstetric manoeuvres with internal rotation of the baby were found as well as all cases of foetal acidosis and reduced Apgar scores, whereas the other babies were born after McRoberts manoeuvre alone. The medium birth weight was not different between the two groups. Therefore, the obstetric procedures as well as the foetal outcome are dependent on foetal biometry. Multiparae do have greater risks for complicated shoulder dystocia compared with primiparae. A BIP-thoracic diameter difference of greater than 14 mm is able to predict probable difficult courses of birth. This means that, from our point of view, ultrasonography close before delivery is an obligate necessity.