Shoulder dystocia

Question 1

RF for SD

Answer 1

Prev SD (10 fold inc)
Diabetic mum (2-4x inc)
Macrosomia >4.5kg
BMI>30
IOL - reduces risk if mat diabetes
Prolonged 1st/2nd stage
2nd stage arrest
Instrumental del
Synto IOL

Question 2

Incidence of SD

Answer 2

0.5-0.7%

Question 3

Risks from shoulder dsytocia

Answer 3

Mum:
PPH risk 11%
OASI 3.8% (2.9% overall)

Baby:
Brachial plexus injury - 0.43/1000
Cooling
HIE
<10% neurological dysfunction

Question 4

Signs of SD

Answer 4

Difficult/slow delivery of head
Turtle necking
No restitution
No decent of shoulders

Question 5

Management

Answer 5

HELP!

Axial traction
McRoberts (resolves 90% of SD)
Discourage pushing

Suprapubic pressure from the side- Tell mum NOT to push
Internal manoeuvres
Epis- Will not release the shoulder, will make space for menoeuvres

Last resort- Cleidotomy, symphysiotomy, Zavanelli- delivery by CS.