![]() ![]() ![]() The anterior fetal shoulder may become impacted behind the maternal pubic symphysis. Fetal fractures typically heal without consequences. Most brachial plexus injuries are transient and resolve with time and physical therapy. Certain "heroic maneuvers" such as the Zavanelli maneuver is associated with significant maternal morbidity. Fetal consequences include fetal brachial plexus injuries, fetal clavicular or humeral fracture, hypoxic ischemic encephalopathy syndrome, and even fetal death. There are potential maternal and fetal consequences following shoulder dystocia. Maternal consequences include postpartum hemorrhage and an increased risk of third or fourth-degree lacerations. Total brachial plexopathies are the rarest form of obstetric plexopathies and are caused by a severe stretch or avulsion type injury. ![]() Lower lesions are caused by traction with the shoulder in full abduction at the time of delivery. Upper lesions result from a lateral flexion of the head away from the affected shoulder, with depression of the ipsilateral shoulder resulting in a C5-6 deficiency. Of the obstetric brachial plexopathies, upper lesions are the most common. Attempts to predict shoulder dystocia based on these risk factors have shown poor reliability and poor predictive value. Other risk factors such as maternal obesity, excessive maternal weight gain, and labor dysfunction are controversial since studies have had conflicting results. Fetal macrosomia is the most significant risk factor for shoulder dystocia. Other known risk factors include pregestational and gestational diabetes, prior history of shoulder dystocia, and operative vaginal delivery, particularly with the use of the vacuum. Several risk factors for shoulder dystocia have been identified. ![]()
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