10/11) Labour & Delivery - Shoulder dystocia Flashcards

1
Q

Incidence of shoulder dystocia

A

1 in 150 (0.7%)

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2
Q

Rate of maternal PPH after shoulder dystopia

A

11%

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3
Q

Rate of obstetric anal sphincter injury after SD

A

3.8%

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4
Q

Rate of brachial plexus injury after SD

A

10%

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5
Q

Proportion of brachial plexus injuries which result in permanent neurological disability

A

10% (46% due to substandard care)

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6
Q

Rate of humeral fractures associated with SD

A

2-12% in cases where posterior arm delivered

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7
Q

Nerve roots involved in Erb’s palsy

A

C5/C6

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8
Q

Proportion of significant SD cases which can be predicted by risk factors

A

16%

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9
Q

Risk of recurrence after previous SD

A

1-25% (10 x increased risk)

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10
Q

Risk of SD in diabetic patients

A

2-4x increased risk for same birthweight

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11
Q

Risk factors for SD

A
  • Previous SD
  • Macrosomia
  • Diabetes
  • IOL
  • Augmentation
  • Instrumental delivery
  • Delay in 1st or 2nd stage
  • BMI >30
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12
Q

Proportion of cases of SD occurring with EFW <4kg

A

48%

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13
Q

Prevention of SD

A
  • 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
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14
Q

Management of SD

A
  • HELP
  • STOP PUSHING
  • McRoberts
  • Suprapubic pressure
  • Internal manoeuvres
  • All fours
  • 3rd line techniques (cleidotomy, symphysiotomy, Zavanelli)
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15
Q

Describe McRoberts

A

Hip flexion and abduction.

Straightens lumbosacral angle, widens AP diameter and rotates pelvis.

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16
Q

Success rate of McRoberts

A

90%

17
Q

Success rate of all fours

A

83%

18
Q

Internal manoeuvres

A

Insert whole hand into sacral hollow (episiotomy if required for access). If posterior arm felt flexed then grab wrist and deliver posterior arm by pulling in a straight line. If posterior arm extended behind baby then aim for internal rotation by applying pressure to posterior aspect of posterior shoulder (or anterior aspect of posterior shoulder).