Shoulder Dystocia: A 10-Year Documented Experience at a Single Obstetric Unit in Port Harcourt

Abstract

Background: Shoulder Dystocia (SD) is an important obstetric emergency with dire consequencies especially for the baby. Periodic evaluation of this important obstetric complication is imperative in improving outcome. This study was to determine the prevalence, evaluate the risk factors, treatment modality and perinatal outcome at the University of Port Harcourt teaching hospital. Materials and Methods: This was a retrospective study of all mothers who had babies with shoulder dystocia during delivery at the University of Port Harcourt Teaching Hospital, over a 10-year period, from January 1st 2010 to December 31st 2019. Relevant information extracted from the case files of affected mothers were analyzed using SPSS version 25 software package. Results were presented in simple frequency tables and percentages. Results: Twenty-one patients had babies with shoulder dystocia over the 10-year period. This constituted 0.4% of all vaginal deliveries during the period under review. The mean age of women who had SD was 35.7±0.79 years. It occurred majorly in primiparous women (47.6%) and most had tertiary level of education 11 (52.4%). Majority of shoulder dystocia occurred in mothers with gestational age of 41 weeks (66.7%) and above. The most common risk factor was maternal obesity observed in 17 (81.0%) patients followed by fetal macrosomia documented in 15 (71.4%) cases. In 33.3% of patients there was no identifiable risk factor. Nineteen ( 90.5% ) babies had various degrees of birth asphyxia and there were two (9.5%) cases of perinatal mortality. The McRobert’s technique was employed successfully in 20 (95.2%) cases. Conclusion: Despite the low prevelence of shoulder dystocia, it still represents a huge risk of morbidity for both the mother and fetus. Prompt diagnosis and prompt intervention with an experienced obstetrician are imperative in averting serious perinatal morbidity and mortality. McRobert’s manœuvre was successful in over 90% of cases.