Shoulder Dystocia Following Vaginal Delivery

Case Overview

Pt was followed for the last 4 months of her pregnancy (from 22 1/2 weeks) by Dr.Jones. He counseled her numerous times to curb her excessive weight gain because of the risk of a large baby. At 25 weeks, her gestational glucose screen was elevated (139; reference range: <130 mg/dL). From 31 weeks, her sugar was noted at every visit as +2.

At 37 5/7 weeks gestation, the fetus’s weight was determined to be 3219 g. by a growth scan (ultrasound?) Pt was not offered a cesarean delivery .
Ms. Jones underwent a vaginal delivery at 39 5/7 weeks gestation. The baby weighed 9 lb. 11 oz. The baby suffered a shoulder dystocia.

Issue
1. Should Dr. have expected the baby to weigh almost 10 lbs. at birth?
2. Should pt have been offered a cesarean delivery?
3. Would a cesarean delivery have prevented the shoulder dystocia?

 

MEDQUEST EXPERT RESPONSE:

3219 is not a large baby. clearly there was an error in the ultrasound which brings up the issue of the quality of the ultrasound and did it meet standards. With the information that they had at 3219 gms a cesarean section was not indicated and it should not have been offered. In most cases, a cesarean section prevents a shoulder dystocia .Dr FG – Maternal Fetal OBGYN