Shoulder Dystocia

Question 1

Shoulder Dystocia

Answer 1

Obstetric emergency when the anterior shoulder of the baby becomes stuck behind the pubic symphysis of the pelvis, after the head has been delivered

Question 2

Risk factors for shoulder dystocia

Answer 2

Macrosomia
Gestational diabetes
Obesity

Question 3

Presentation of shoulder dystocia

Answer 3

Difficulty delivering the face and head, and obstruction in delivering the shoulders after delivery of the head.

Failure of restitution - head remains face downwards (occipito-anterior) and does not turn sideways as expected

The turtle-neck sign

Question 4

Turtle-neck sign

Answer 4

Where the head is delivered but then retracts back into the vagina

Question 5

Management of shoulder dystocia

Answer 5

Managed by experienced midwives and obstetricians.

1. Get help - anaesthetics and paediatrics
2. Specific manoeuvres can be done
   - McRoberts manoeuvre
   - Pressure to the anterior shoulder
   - Rubins manoeuvre
   - Wood’s screw manoeuvre
   - Zavanelli manoeuver
3. Episiotomy

Question 6

McRoberts manoeuvre

Answer 6

Hyperflexion of the mother at the hip (bringing her knees to her abdomen).

Provides a posterior pelvic tilt, lifting the pubic symphysis up and out of the way

Question 7

Pressure to the anterior shoulder

Answer 7

Pressing on the suprapubic region of the abdomen. This puts pressure on the posterior aspect of the baby’s anterior shoulder, to encourage it down and under the pubic symphysis

Question 8

Rubins manoeuvre

Answer 8

Reaching into the vagina to put pressure on the posterior aspect of the baby’s anterior shoulder to help it move under the pubic symphysis

Question 9

Wood’s screw manoeuvre

Answer 9

Performed during a Rubins manoeuvre.

The other hand reaches in the vagina and puts pressure on the anterior aspect of the posterior shoulder

The top shoulder is pushed forwards, and the bottom shoulder is pushed backwards, rotating the baby and helping delivery.

If does not work, the reverse motion can be tried, pushing the top shoulder backwards and the bottom shoulder forwards.

Question 10

Zavanelli manoeuver

Answer 10

Pushing the baby’s head back into the vagina so that the baby can be delivered by emergency Caesarean section

Question 11

Complications of shoulder dystocia

Answer 11

Fetal hypoxia (and subsequent cerebral palsy)

Brachial plexus injury and Erb’s palsy

Perineal tears

Postpartum haemorrhage