10: Dystocia

Question 1

Dystocia def

Answer 1

labor that isn’t progressing

Question 2

Shoulder dystocia

Answer 2

anterior shoulder lodges above pubic bone

Question 3

Incidence of shoulder dystocia

Answer 3

1/1000 babies

increased incidence in >8.5 lbs

Question 4

How fast should you be when you recognize it?

Answer 4

FAST. 4-6 minutes

Question 5

History questions so you don’t get yourself in this situation sans preparedness

Answer 5

is her pelvis adequate? look at US–is head in 90%? is she post-dates?

Question 6

Failure to rotate

Answer 6

assoc with asynclitism

or baby’s hands behind back

Question 7

Prenatal risks

Answer 7

obese/diabetic mom
small mom with huge dad
macrosomia
hx of macrosomia/shoulder dystocia

Question 8

Intrapartum dx

Answer 8

long, hard labor (despite good UCs)
long, slow pushing
US suggests macrosomia

Question 9

Warning sign at delivery

Answer 9

head delivers slowly, jerks
cant find neck
cant see ant shoulder
head and scalp become purply with venous congestion
*hve mom push to see if anything changes

Question 10

DDX for shoulder dystocia

Answer 10

compound pres, incomplete cervical dilation (fetal demise, anencephaly), fetal trunk enlargement (ascites, tumor), uterine constriction ring

Question 11

Management at hospital

Answer 11

exagerrated lithotomy with suprapubic P

Question 12

Management OOH

Answer 12

hands and knees! reach in, tissue pull at axilla; grab elbow and pull arm out
all else fails: fracture collarbone