2012 42 Shoulder Dystocia Flashcards
Which bone-on-bone impact leads to shoulder dystocia?
Anterior shoulder on symphysis pubis
Posterior shoulder on sacral promontory
What is the incidence of shoulder dystocia?
0.58-0.7%
What are the maternal complications of shoulder dystocia?
- PPH 11%
- OASI 3.8%
- Vaginal & cervical lacerations
- Bladder rupture
- Uterine rupture
- Symphyseal separation
- Sacroiliac joint dislocation
- Lateral femoral cutaneous neuropathy
What are the fetal complications of shoulder dystocia?
1.Brachial plexus injury 2.3-16%
<10% of these permanent neuro dysfunction
2. Fractures of humerus or clavicle
3. Pneumothorax
4. Hypoxic brain damage
What proportion of brachial plexus injuries occur at CS?
4-12%
What are the pre-labour risk factors for shoulder dystocia?
- Previous shoulder dystocia
- Macrosomia > 4.5kg
- Diabetes
- Maternal BMI > 30
- Induction of labour
What are the intrapartum risk factors for shoulder dystocia?
- Prolonged 1st stage
- Secondary arrest
- Prolonged 2nd stage
- Oxytocin augmentation
- Assisted vaginal delivery
In what circumstances can IOL prevent shoulder dystocia?
- GDM by IOL from 38/40
- Not suspected macrosomia in absence of diabetes
In what circumstances should ElCS be considered for LGA?
EFW > 4.5kg
How is the rate of shoulder dystocia impacted by previous?
10x
What are the signs of potential shoulder dystocia?
- Difficulty with delivery of face & chin
- Turtle neck sign: head remaining tightly applied to vulva or retracting
- Failure of restitution of fetal head
- Failure of shoulders to descend
What kind of traction should be used to deliver the shoulders?
- Routine axial traction
- In line with fetal spine, no lateral deviation
What is the stepwise management algorithm for shoulder dystocia?
Call for help!
1. McRobert’s manoeuvre
2. Suprpubic pressure
3. Episiotomy for manoeuvres
4. Internal rotational manoeuvres +/- deliver posterior arm
5. All-fours position & repeat 1-4
6. Consider cleidotomy, Zavanelli manoeuvre or symphysiotomy
What is the stepwise management algorithm for shoulder dystocia?
Call for help!
1. McRobert’s manoeuvre
2. Suprpubic pressure
3. Episiotomy for manoeuvres
4. Internal rotational manoeuvres +/- deliver posterior arm
5. All-fours position & repeat 1-4
6. Consider cleidotomy, Zavanelli manoeuvre or symphysiotomy
At shoulder dystocia, what proportion of babies that died did so within 5 minutes of the head being delivered?
47%
