Shoulder dystocia

Question 1

What are the risks factors of shoulder dystocia?

Answer 1

• Previous shoulder dystocia
• Macrosomia
• Post term pregnancy
• High parity
• Prolonged second stage and transition in labour
• Assisted vaginal delivery – instrumental.
• Epidural block and analgesia

Question 2

What are the three signs of a shoulder dystocia?

Answer 2

• Head that advances slowly + chin has difficulty sweeping the perineum
• Turtling of the head
• No restitution

Question 3

What management is involved in a true shoulder dystocia? In order

Answer 3

• Call for help – call an obstetric code pink and a neonatal code blue, explain to parents that many people will enter the room to help baby get passed the last part of birth.
• McRoberts manoeuvre – knees to nipples.
• Suprapubic pressure
• Delivery of the posterior arm – pringles grasp.
• Consider Gaskins manoeuvre
• Document and Debrief

Question 4

What are the other less common manoeuvres to consider?

Answer 4

Corks screw manoeuvre, Reubens manoeuvre, rare – zavanelli manoeuvre

Question 5

What are the risks to be aware of for the mother after a shoulder dystocia?

Answer 5

PPH
Perineum suturing
Anxiety and birth trauma

Question 6

What are the risks to be aware of for the neonate after a shoulder dystocia?

Answer 6

Neonatal resus - should anticipate and call a neonatal code blue when shoulder dystocia is suspected