SHOULDER DYSTOCIA

Question 1

What is the definition of Shoulder Dystocia?

Answer 1

an obstetric emergency, whereby the fetal anterior shoulder becomes trapped behind the symphysis pubis. (Shah, 2016)

Question 2

What is the incidence rate of Shoulder Dystocia?

Answer 2

1 in 150 / 0.7% vaginal deliveries.

Question 3

What antenatal risk factors are there?

Answer 3

GDM
Raised BMI
Previous shoulder dystocia or LGA (Macrosomia)

Question 4

What intrapartum risk factors are there?

Answer 4

IOL

Assisted Delivery

Question 5

What supporting evidence is there regarding obesity and shoulder dystocia?

Answer 5

Vetterlain et al. (2021) 19/1000 of obese women encountered shoulder dystocia.

Question 6

What are some warning signs that Shoulder Dystocia may occur?

Answer 6

The fetal head took long to advance.

Chin has difficulty sweeping perineum.

Question 7

First steps taken when Shoulder Dystocia occurs?

Answer 7

Call for help (SOAPS).
Discourage pushing.
Move mother to edge of bed.

Question 8

Who are SOAPS?

Answer 8

Senior midwife
Obstetrician
Anaesthetist (sometimes)
Paeds/Neonatologist 
Scribe

Question 9

What is the need for SOAPS?

Answer 9

Senior midwife and Obstetrician for expertise.
Anaesthetist is sometimes needed in case further emergency develops.
Paeds/Neonatologist to attend to baby after birth.
Scribe to ensure accurate detail in notes.

Question 10

Second stage taken when Shoulder Dystocia occurs?

Answer 10

McRoberts Manoeuver and Suprapubic pressure.

Question 11

What is the McRoberts manoeuver?

Answer 11

Knees to chest manoeuver, as it widens the pelvic outlet and flattens the sacral promontory and thus increases lumbosacral angle.

Question 12

What is the effectiveness rate of McRoberts manoeuver?

Answer 12

40% success rate - Gesner (2020)

24.8% success rate - PROMPT (2017)

Question 13

What is suprapubic pressure?

Answer 13

Pressure is applied to the maternal lower abdomen over the pubic bone and a rocking motion is used to release the shoulder.

Question 14

What is the effectiveness of McRoberts and Suprapubic pressure?

Answer 14

90% success rate - Diaz (2020).

Question 15

Third stage taken when Shoulder Dystocia occurs?

Answer 15

Delivery of the posterior arm.

Question 16

How is delivery of the posterior arm performed?

Answer 16

Pressure on the antecubital fossa causes fetus to flex elbow in front of the body -> grasp posterior hand and sweep arm across the chest -> deliver the arm

Question 17

What happens after delivery of the arm?

Answer 17

Rotate the fetus into oblique diameter -> bring anterior shoulder under the symphysis pubis.

Question 18

If 1-3 fail, what is the next step?

Answer 18

Internal manoeuvers commence: Rubins II and Wood’s screw.

Question 19

What is Rubins II manoeuver?

Answer 19

Pressure on the posterior aspect of the anterior shoulder pushes arm towards chest -> causes shoulders to rotate forwards -> downwards traction

Question 20

What is Woods Screw manoeuver?

Answer 20

Both hands uses -> 1 in Rubins II manoeuver, 2nd places pressure on anterior aspect of posterior shoulder -> move into oblique diameter -> deliver.

Question 21

After delivery, what should happen?

Answer 21

Neonate to be checked over

Debrief, Documentation, & Datix

Question 22

What is % of PPH after delivery?

Answer 22

11% - RCOG, (2012)

Question 23

What is the % of Brachial Plexus Injury?

Answer 23

Up to 16% - Yenigul, (2020)