Intrapartum Care - Shoulder Dystocia

Question 1

What is Shoulder Dystocia?

Answer 1

OBSTETRIC EMERGENCY : The anterior shoulder of the baby becomes stuck behind the pubic symphysis of the pelvis after delivery of the head.

Question 2

Risk Factors of Shoulder Dystocia (4).

Answer 2

1. Macrosomia, secondary to Gestational Diabetes.
2. High Maternal BMI.
3. Diabetes Mellitus.
4. Prolonged Labour.

Question 3

Clinical Presentation of Shoulder Dystocia (4).

Answer 3

1. Difficulty Delivering Face/Head.
2. Obstruction in Delivering Shoulders.
3. Failure of Restitution (Head does not turn sideways after delivery).
4. Turtle-Neck Sign : Head is delivered but retracts back into vagina.

Question 4

Management of Shoulder Dystocia.

Answer 4

1. Escalation.
2. Manoeuvres (McRobert’s).
3. All 4s Position, Other Manoeuvres
4. Episiotomy (for other Manoeuvres).
5. Cleidotomy/Symphysiotomy and Zavanelli’s Manoeuvre.

Question 5

What is an Episiotomy?

Answer 5

A method to enlarge the vaginal opening and reduce the risk of perineal tears.

Question 6

What manoeuvres can be used to manage Shoulder Dystocia? (5)

Answer 6

1. McRoberts’ (Hyperflexion of Mother at Hip = Posterior Pelvic Tilt).
2. Pressure to Anterior Shoulder (on Suprapubic Region to pressure the posterior aspect of the anterior shoulder).
3. Rubins’ (pressure the posterior aspect of the anterior shoulder intravaginally).
4. Wood’s Screw (other hand of Rubins’ - pressure on anterior aspect of posterior shoulder to rotate the baby).
5. Zavanelli’s (push baby’s head back for emergency C-Section).

Question 7

Complications of Shoulder Dystocia (4).

Answer 7

1. Foetal Hypoxia (and Subsequent Cerebral Palsy).
2. Brachial Plexus Injury and Erb’s Palsy.
3. Perineal Tears.
4. Postpartum Haemorrhage.