Cleidotomy

Cleidotomy

The cause of arrest of labour may be shoulder dystocia.

The underlying cause is generally foetal macrosomia.

Infants of diabetic mothers and postdated babies may be large in size and cause dystocia, hence in patients in whom foetal macrosomia is expected, a sonographic scan to assess foetal size and approximate weight often provides the clue to the expected dystocia. If the foetus weighs >3.8 kg, the obstetrician may opt for a caesarean delivery. However, when faced up with unexpected shoulder dystocia, undertake shoulder dystocia drill of manipulating the body to bring down one shoulder, try to deliver the shoulders in the oblique diameter, ask an assistant to apply suprapubic pressure on mother's abdomen.

As a last resort, the operator may divide the foetal clavicle on one side.

The shoulder girdle collapses, delivery is then accomplished. The skin incision over the bone is sutured, and a "figure of 8" binder given to help the clavicle heal. This operation may be performed on a living baby if the clinical situation demands.