What is the appropriate mode of delivery after a previous shoulder dystocia?

 

  • The rate of SD in women who have had a previous SD has been reported to be 10 times higher than the rate in the general population.There is a reported recurrence rate of SD of between 1% and 25%.May be an underestimate due to selection bias,as CS may have been advocated for pregnancies after severe SD esp with a poor neonatal outcome.(Level 3 evid).
  • Either CS or vaginal delivery can be appropriate.(Recommendation Level D).There is no requirement to recommend elective CS routinely,but factors such as severity of any previous neonatal or maternal injury,predicted fetal size and maternal choice should all be considered and discussed with the woman and her family,in planning the next delivery.(Level 4 evid)