9.9 Shoulder Dystocia

Question 1

Which shoulder is stuck in a shoulder dystocia?

Answer 1

the anterior shoulder is stuck behind the pubic sumphysis

obstetric emergency

Question 2

What is a common cause of shoulder dystocia?

Answer 2

macrosomia secondary to gestational diabetes.

Question 3

What suggests there is shoulder dystocia?

Answer 3

• difficulty delivering the face and head and particularly shoulders

There may be:

• failure of RESTITUTION (head remain OA and doesnt turn sideways)
• TURTLE NECK sign (head is delivered but then retract back into vagina a bit)

Question 4

What mnemonic aids with the steps to manage shoulder dystocia?

Answer 4

H
E
L
P
E
R
R

Question 5

What does HELPERR stand for in shoulder dystocia?

Answer 5

Help (anaesthetics and paeds)
Episiotomy
Legs up
Pressure ant. shoulder
Enter vagina
Remove post. arm
Roll to knees

Question 6

What manoeuvre provides a posterior pelvic tilt shoulder dystocia?

Answer 6

McRoberts manoeuvre

Hyperflexion at the hip (knees to abdomen). Provides posterior pelvic tilt, lifting the pubic symphysis out of the way.

(Legs in HELPERR)

Question 7

What manoeuvre involves entering the vagina in shoulder dystocia?

Answer 7

RUBIN’S manoeuvre
- pressure on posterior aspect of baby’s anterior shoulder

WOOD’S SCREW manoeuvre

• during a Rubin’s
• other hand puts pressure on anterior aspect of posterior shoulder. The top shoulder is pushed forwards, and the bottom shoulder is pushed backwards, rotating the baby and helping delivery.
• if this does not work, the reverse motion can be tried, pushing the top shoulder backwards and the bottom shoulder forwards.

Question 8

What manoeuvre for shoulder dystocia means you are going to try a c-section?

Answer 8

Zavanelli manoeuver

- pushing the baby’s head back into the vagina deliver by emergency c-section.

Question 9

What are the complications of shoulder dystocia?

Answer 9

• Fetal hypoxia (and subsequent cerebral palsy)
• Brachial plexus injury and Erb’s palsy
• Perineal tears
• Postpartum haemorrhage