Columbus & ACOG PB: shoulder dystocia Flashcards
Define shoulder dystocia.
Failure of the fetal shoulders to deliver despite routine obstetric maneuvers.
Head-to-body delivery interval of greater than 60 seconds.
Usually caused by impaction of anterior fetal shoulder behind the maternal pubic symphysis; rarely caused by posterior fetal shoulder impaction on the maternal sacral promontory
What is the incidence of shoulder dystocia?
What percentage of these result in brachial plexus injuries?
What percentage are permanent?
1%
4-16%
10% of transient rate - about 1% of all shoulder dystocia.
What percentage of brachial plexus injuries are not associated with shoulder dystocia?
34-47%; 4% occur after cesarean delivery.
What percentage of shoulder dystocia occurs with no risk factors?
50%
Over half of shoulder dystocia cases occur in neonates less than 4000 g
What additional neonatal complications are associated with shoulder dystocia?
Maternal complications?
Fractured clavicle or humerus 5-10%
Severe birth asphyxia 0.3%
Death 0.1%
Postpartum hemorrhage 11%
Fourth degree perineal laceration 4%
What are risk factors for shoulder dystocia?
Previous shoulder dystocia: 10-17% recurrence Maternal diabetes Fetal macrosomia Maternal obesity Multiparity Postterm gestation Previous macrosomia Operative vaginal delivery Induction of labor
Prophylactic cesarean section to prevent shoulder dystocia is offered at what estimated fetal weight?
5000 g in women without diabetes
4500 g with diabetes
If elective cesarean were offered for an estimated fetal weight greater than 4000 g, how many procedures would need to be performed to prevent one permanent brachioplexus injury?
2345.
At a cost of $4.9 million annually
Describe suprapubic pressure maneuver.
Performed by assistant on a stepstool. Pushes the shoulder below the pubic synthesis. Avoid fundal pressure.
Describe McRoberts maneuver.
Hyperflexion of the thighs. Increases the posterior pelvic outlet diameter. This maneuver alone resolves 42% of shoulder dystocia
Describe delivery of posterior arm.
Operator hand is inserted posteriorly along the sacrum to grasp the fetal arm and sweep it across the fetal thorax. The shoulder girdle is rotated obliquely. Clavicle fracture rate is 25%, humerus fracture 15%. Highest rate of success compared to other maneuvers.
Describe Rubin maneuver.
Pressure applied to posterior aspect of anterior shoulder ADducts the shoulders and reduces the bisacromial diameter.
Describe Gaskin maneuver.
Mother is placed on hands and knees and infant is delivered with gentle downward traction on posterior shoulder or upward traction on the anterior shoulder.
Describe the Woods screw maneuver.
Pressure is applied to anterior aspect of the posterior shoulder.
Describe Zavanelli procedure.
Administer terbutaline 0.25 subcutaneous or nitroglycerin 50-100 µg IV Place scalp electrode Flex the head and push cephalad. Insert Foley Perform emergency cesarean
