shoulder dystocia

Question 1

what is shoulder dystocia ?

Answer 1

a vaginal cephalic delivery that requires additional obstetric maneuver to deliver the fetus after head was delivered and gentle traction has failed

Question 2

where is the impaction with shoulder dystocia ?

Answer 2

anterior shoulder is impacted with the symphysis pubis

posterior shoulder is impacted with sacral promontory

Question 3

what is the most common complication of shoulder dystocia ?

Answer 3

brachial plexus injury

Question 4

what are the pre-labour factors associated with shoulder dystocia ?

Answer 4

diabetes 
macrosomia 
previous shoulder dystocia 
induction of labour 
BMI above 30

Question 5

what are the intrapartum factors associated with shoulder dystocia ?

Answer 5

prolonged 1st stage 
secondary arrest 
prolonged 2ry stage 
oxytocin augmentation 
assisted vaginal delivery

Question 6

what is the effect of induction of labour on shoulder dystocia ?

Answer 6

1. does not reduce the incidence in non diabetic mothers with macrosomic babies
   2 .does decrease the incidence in diabetic mothers

Question 7

how is shoulder dystocia diagnosed ?

Answer 7

1. difficulty in delivering the face and the chin
2. the head remaining tightly applied to the vulva or event retracting ( turtle neck sign )
3. failure of restitution of the fetal head
4. failure of the shoulders to descend

Question 8

initially how should shoulder dystocia be managed ?

Answer 8

no fundal pressure should be applied
mother asked not to strain
McRoberts maneuver should be applied along with supra-pubic pressure

Question 9

what is Mcroberts maneuver ?

Answer 9

flexion and abduction of the maternal pelvis by asking the mother to bend her knees against her

Question 10

what is the purpose of Mcroberts maneuver ?

Answer 10

increases the relative anterior-posterior diameter of the pelvis

Question 11

is an episiotomy useful is SD ?

Answer 11

no effect on SD or BPI , may only be needed to facilitate internal vaginal access

Question 12

what is the internal maneuver ?

Answer 12

inserting the hand fully posteriorly into the vagina where the sacral hollow is and rotating the trunk in an oblique manner or 180 if possible and delivery by the posterior arm

Question 13

what is the best next step if Mcroberts and SPP fails ?

Answer 13

use internal maneuver and all fours technique

Question 14

what must you be wary of when using third line maneuvers ?

Answer 14

that after 5 minutes the fetus will start to become hypoxic

Question 15

what are the third line maneuvers ?

Answer 15

zavanelli maneuver
cleidotomy
symphysiotomy

Question 16

what are the 2 types of BPI ?

Answer 16

upper injury : erb’s palsy C5, C6

lower injury : klumpke’s palsy C7, C8 and T1