SHOULDER PRESENTATION

When the fetus lies with its long axis across

the long axis of the uterus the shoulder is
most likely to present.Ocassionally the lie is
oblique but this does not persist, as the
uterine contractions during labour make it
either longitudinal or transverse.
The head lies on one side of the abdomen,
with the breech at a slightly higher level on
the other. The fetal back may be anterior or
posterior
 Maternal causes:
*Lax abdominal & uterine muscles
*Uterine abnormality
*Contracted pelvis
Fetal causes:
*Preterm pregnanacy
*Multiple pregnancies
*Polyhydramnios
*Macereated fetus
*Placenta previa
DIAGNOSIS:
Antenatal:On abdominal palpation:
*the uterus appears broad
*fundal height is less than expected for the
period of gestation
*On pelvic palpation neither head nor
breech is felt
*The mobile head is found at one side of
the abdomen & the breech at a slightly
higher level at the other.
*Ultrasound examination
Intrapartum:
*The findings on abdominal palpation are as
when membranes are intact
*after rupture of membranes-irregular outline
of the uterus is marked.
*Vaginal examination should not be performed
without excluding placenta previa.
*if the labour has been progress for some
time,the shoulder may be felt as a soft mass &
ribs with their grid-iron pattern
*With further progress of labor,an arm may
prolapse.
Management in the Antenatal period:
*Elective caesarean section: Placenta
preavia or contracted pelvis
*External version ,if this fails or if the
lie changes to transverse after an
external version ,the woman is
admitted in the hospital until delivery
to prevent cord prolapse.
Management in the Intrapartum period:
*If transverse lie with intact membranes-
External version followed by controlled rupture
of membranes.
If the membranes have ruptures spontaneously
a vaginal examination must be performed to
detect cord prolapse.
Immediate Cesarean section is performed:
*If the cord prolapse
*When the membranes have already ruptured
*When external version is unsuccessful
*When labor has already been in progress for
Complications:
*Prolapse of cord
*Prolapse of arm
*Obstructed labor
*Fetal death
Management:
Immediate cesarean section
under general anasthesia.