Shoulder Dystocia

Question 1

What happens in shoulder dystocia?

Answer 1

• the anterior shoulder of the baby becomes stuck behind the pubic symphysis
• this occurs after delivery of the head

it is an OBSTETRIC EMERGENCY

Question 2

What usually causes shoulder dystocia?

Answer 2

it usually occurs due to macrosomia secondary to gestational diabetes

Question 3

How does shoulder dystocia present?

Answer 3

• there is difficulty in delivery of the shoulders following delivery of the head
• there may be failure of restitution as the baby remains occipitoanterior and does not turn sideways
• turtle-neck sign may be present

Question 4

What is turtle-neck sign?

Answer 4

the head is delivered and then retracts back into the vagina

Question 5

What are the different techniques that may be used to help delivery when there is shoulder dystocia?

Answer 5

• episiotomy
• McRobert’s manoeuvre
• pressure to anterior shoulder
• Rubin’s manoeuvre
• Wood’s screw manoeuvre
• Zavanelli manoeuvre

Question 6

What is McRobert’s manoeuvre?

Answer 6

• the mother is hyperflexed at the hip (knees up to abdomen)
• this provides a posterior pelvic tilt that lifts the pubic symphysis up

Question 7

How is pressure to the anterior shoulder achieved?

Answer 7

• a hand presses on the suprapubic region of the abdomen
• this puts pressure on the posterior aspect of the anterior shoulder to encourage it down and under the pubic symphysis

Question 8

What is involved in Rubin’s manoeuvre?

Answer 8

• a hand is inserted through the vagina
• pressure is applied to the posterior aspect of the anterior shoulder
• this helps to move it under the pubic symphysis

Question 9

What is involved in a Wood’s screw manoeuvre?

Answer 9

• performed during a Rubin’s manoeuvre
• pressure is applied to the anterior aspect of the posterior shoulder
• this rotates the baby by 180 degrees to aid delivery

if this fails, the reverse motion can be tried

Question 10

What is the Zavanelli manoeuvre?

Answer 10

• the baby’s head is pushed back into the vagina
• this allows for delivery by emergency C-section

Question 11

What are the key complications of shoulder dystocia?

Answer 11

• fetal hypoxia resulting in cerebral palsy
• brachial plexus injury resulting in Erb’s palsy
• perineal tears
• postpartum haemorrhage