Shoulder Dystocia

Question 1

What is shoulder dystocia?

Answer 1

Difficulty with delivering fetal shoulders following delivery of the head.

Question 2

What is the aetiology of shoulder dystocia?

Answer 2

Bony impaction of the anterior fetal shoulder behind maternal symphisis pubis.

Question 3

What are the RFs of shoulder dystocia?

Answer 3

High BW, post dates, previous SHD DM, obesity, instrumental delivery, prolonged labour.

Question 4

What is the epidemiology of shoulder dystocia?

Answer 4

1%

Question 5

What are the Hx/ Ex findings of shoulder dystocia?

Answer 5

Delat in delivery of shoulders, turtlenecking of fetal head.

Evidence a/a

Question 6

What is the management of shoulder dystocia?

Answer 6

Mnemonic HELPERR. Each manouvre for 30 seconds. DOCUMENT!!

· H: Help call.

· E: evaluate episiotomy

· L: Legs – McRoberts manouvre hyperflex maternal thight onto the abdomen.

· P: Pressur suprapubically to posterior aspect of fetal shoulder.

· E: Enter manouvres: for internal rotation of fetal shoulder in oblique plane.

· R: remove posterior arm

· R: roll patient to all fours.

Manouvres in lat resort include deliberate clavicular fracture, symphysiotomy, general anaesthesia and Zavanelly manouvre (replacement of fetal head and following C seciton).

Question 7

What are the complications and prognosis of shoulder dystocia?

Answer 7

Maternal PPH, rupture, extensive perineal tears (3rd/4th degree). Symphyseal separation.

Detal: death, HIE, fractured humerus or clavicle, brachial plexus injury.

Perinatal mortality 1-2%. ¼ of infants with brachial plexus injury. 10-15% recur in future pregnancy.