title: [Shoulder dystocia: an obstetrical emergency].
abstract: Shoulder dystocia is one of the most feared obstetric emergencies due to related maternal and neonatal complications and therefore, the growing of medico-legal litigation that it entails. Although associated with risk factors such as fetal macrossomia, gestacional diabetes and instrumented delivery, the majority of cases are unpredictable. The lack of a consensus on shoulder dystocia diagnosis causes variations on its incidence and hampers a more comprehensive analysis. Management guidelines described for its resolution include several manoeuvres but the ideal sequence of procedures is not clearly defined in more severe cases. Hands-on and team training, through simulation-based techniques applied to medicine, seems to be a promising method to learn how to deal with shoulder dystocia having in mind a reduction in related maternal or neonatal morbidity and mortality. The main goal of this paper is to provide a comprehensive revision of shoulder dystocia highlighting its relevance as an obstetric emergency. A reflection on the management is presented emphasising the importance of simulation-based training.
authors.affiliation: Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina da Universidade do Porto, Portugal.
authors.forename: Joana Borges
authors.initials: JB
authors.lastname: Marques
authors.forename: Ana
authors.initials: A
authors.lastname: Reynolds
mesh_terms: D036861:Delivery, Obstetric / Q000193:education / Q000379:methods; D004420:Dystocia / Q000175:diagnosis / Q000628:therapy*; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007746:Labor Presentation; D011247:Pregnancy; D012782:Shoulder