10/11) Labour & Delivery - Shoulder dystocia Flashcards
Incidence of shoulder dystocia
1 in 150 (0.7%)
Rate of maternal PPH after shoulder dystopia
11%
Rate of obstetric anal sphincter injury after SD
3.8%
Rate of brachial plexus injury after SD
10%
Proportion of brachial plexus injuries which result in permanent neurological disability
10% (46% due to substandard care)
Rate of humeral fractures associated with SD
2-12% in cases where posterior arm delivered
Nerve roots involved in Erb’s palsy
C5/C6
Proportion of significant SD cases which can be predicted by risk factors
16%
Risk of recurrence after previous SD
1-25% (10 x increased risk)
Risk of SD in diabetic patients
2-4x increased risk for same birthweight
Risk factors for SD
- Previous SD
- Macrosomia
- Diabetes
- IOL
- Augmentation
- Instrumental delivery
- Delay in 1st or 2nd stage
- BMI >30
Proportion of cases of SD occurring with EFW <4kg
48%
Prevention of SD
- IOL does not prevent SD in non-diabetic mothers with macrosomic baby
- IOL at term may reduce SD risk in diabetic mothers with macrosomic baby
- CS may reduce morbidity in DM >4.5kg or non-DM >5kg
Management of SD
- HELP
- STOP PUSHING
- McRoberts
- Suprapubic pressure
- Internal manoeuvres
- All fours
- 3rd line techniques (cleidotomy, symphysiotomy, Zavanelli)
Describe McRoberts
Hip flexion and abduction.
Straightens lumbosacral angle, widens AP diameter and rotates pelvis.