Shoulder Dystocia Flashcards
What is shoulder dystocia?
Where the anterior fetal shoulder becomes lodged behind the maternal pubic symphysis following delivery of the fetal head
What are the risk factors for shoulder dystocia?
Maternal gestational diabetes
Macrosomia
Birth weight > 4kg
Advanced maternal age
Maternal short stature
Maternal obesity
Post dates pregnancy
What are the features of shoulder dystocia?
Difficulty delivering the face and head
Failure of restitution
Turtle neck sign
Failure of descent of fetal shoulders following delivery of the head
What is failure of restitution?
Where the head remains face downwards after delivery and does not turn sideways as expected
What is the turtle neck sign?
Where the head is delivered but retracts back into the vagina
What is the management of shoulder dystocia?
Immediately call for help
McRoberts manoeuvre
Rubins manoeuvre
Wood’s screw manoeuvre
Zavanelli manoeuvre
What is McRoberts manoeuvre?
The maternal hips and hyperflexed and abducted. This provides a posterior pelvic tilt to move the pubic symphysis up and out of the way
What is Rubins manoeuvre?
Rubins manoeuvre involves reaching into the vagina to put pressure onto the posterior aspect of the anterior fetal shoulder. This helps to move the shoulder under the maternal pubic symphysis
An episiotomy may be performed to allow space for internal manoeuvres
What is Wood’s screw manoeuvre?
This is performed during the Rubins manoeuvre. The anterior aspect of the posterior fetal subjected is pushed in order to rotate the baby and help delivery
What is the Zavanelli manoeuvre?
The baby’s head is pushed back into the vagina so that the baby can be delivered by emergency C section
What are the complications of shoulder dystocia?
Fetal hypoxia (and subsequent cerebral palsy)
Brachial plexus injury (and Erb’s palsy)
Fetal death
Perineal tears
PPH
Uterine rupture
What is Erb’s palsy?
Paralysis of the arm caused by damage to the C5-C6 nerve roots of the brachial plexus
