Although there are no methods to predict

Although there are no methods to predict or prevent shoulder dystocia, the nurse should be alert to clinical indicators: slowed labor progression and formation of a caput succedaneum that increases in size. When the fetal head emerges on the perineum (crowning), it retracts instead of protruding with subsequent contractions (termed the turtle sign), and external rotation does not occur. Fetal/neonatal injuries are related to birth asphyxia, damage to the brachial plexus (e.g., Duchenne-Erb paralysis or Klumpke’s paralysis), and fractures, usually of the humerus or clavicle. Maternal injury is most commonly associated with excessive blood loss that results from uterine atony or rupture; other risks include lacerations, extension of the episiotomy, rectovaginal fistula, symphyseal separation, and postpartum endometritis. Shoulder dystocia is an emergency that requires a team effort. Once the nurse suspects shoulder dystocia, he or she must summon help to assist with the different maneuvers to deliver the infant. SCIENCE HEALTH SCIENCE NURSING

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