Shoulder Dysocia

Question 1

What is shoulder dystocia?

Answer 1

occurs when the anterior shoulder impacts on the maternal symphysis pybis or, less commonly, the posterior fetal shoulder impacts against the sacral promontory

Question 2

what are traditional risk factors for shoulder dystocia?

Answer 2

1. previous history of shoulder dystocia
2. macrosomia
3. diabetes
4. induction of labour
5. short stature & small abnormal pelvis
6. body mass index >30kg/m2
7. Instrumental birth

Question 3

how much fold does gestational diabetes increase shoulder dystocia by?

Answer 3

3 fold

Question 4

when is there an increase of 10 fold?

Answer 4

the amount of maternal weight gained throughout pregnancy is in excess of 20kg

Question 5

what are the intrapartum characteristics that may indicate shoulder dystocia?

Answer 5

1. a high head at term
2. prolonged 1st or 2nd stage of labour
3. oxytocin augmentation
4. failure of the head to descend
5. instrumental births
6. head retraction between contractions in second stage
7. difficulty with delivery of face and chin
8. failure of restitution
9. turtle sign

Question 6

what are potential maternal complications of shoulder dystocia?

Answer 6

1. PPH due to uterine atony or trauma
2. soft tissue injuries
3. psychological trauma

Question 7

what is one of the most serious neonatal complications of shoulder dystocia?

Answer 7

hypoxic ischemic encephalopathy

Question 8

what is hypoxic ischemic encephalopathy?

Answer 8

compression of the umbilical cord between the fetal body and maternal pelvis during shoulder dystocia, leading to fetal hypoxia

Question 9

fetal pH can drop at a rate of what per minute?

Answer 9

0.4 per minute

Question 10

how long should each manoeuvre be attempted for?

Answer 10

max 30 seconds

Question 11

what can be done to minimus the risks of complications?

Answer 11

1. establish clear and concise clinical guidelines
2. identify at risk women and involve experienced clinicians in planning her labour management
3. document a mutually acceptable management plan
4. monitor labour progress
5. seek help early
6. maintain competency in all manoeuvres
7. maintain infant resuscitation skills and ensure equipment available and ready to use

Question 12

what should be the first then 2nd attempted manoeuvre?

Answer 12

McRoberts then Supra Public Pressure if it fails

Question 13

what does McRoberts’ and Gaskins/All-fours try result to?

Answer 13

Increase the anterposterior diameter/functional size of the bony pelvis

Increases the anteroposterior diameter of the pelvic inlet

Question 14

what does external manoeuvre (supra public pressure and Rubins I) and internal manoeuvre (delivery of posterior arm) try result to?

Answer 14

decrease the bisacromial diameter of the shoulders

Question 15

what times should be noted when shoulder dystocia has been diagnosed?

Answer 15

• time head was delivered
• time of delivery of the posterior arm
• manoeuvres performed, the timing and sequence
• traction applied
• time of delivery of the body
• staff in attendance, time each member arrived
• condition of baby
• cord pHs

Question 16

How is the McRoberts manoeuvre performed?

Answer 16

1. lie mum flat, with her buttocks over the end of the bed
2. thighs flexed, adducted and rotated outwards so they touch maternal abdomen
3. remove end of bed

Question 17

What is the pneumonic for shoulder dystocia?

Answer 17

H - call for HELP
E - EVALUATE for EPISIOTOMY
L - LEGS (McRoberts maneuver)
P - suprapubic PRESSURE
E - ENTER: rotational maneuvers
R - REMOVE the posterior arm
R - ROLL the patient to her hands and knees