Shoulder dystocia

Question 1

What is a shoulder dystocia?

Answer 1

vaginal cephalic birth that requires additional obstetric manoeuvres to assist the birth of the fetus

Question 2

What happens during a shoulder dystocia?

Answer 2

anterior shoulder impacts behind the maternal symphysis pubis

Question 3

Incidence?

Answer 3

0.6-3%

Question 4

Who is at risk?

Answer 4

Instrumental, prolonged first/second stage, maternal obesity, DM

Question 5

What are the fetal complications?

Answer 5

Death, Hypoxia, Fractured clavicle or humerus, Brachial plexus injuries

Question 6

Maternal complications?

Answer 6

Postpartum haemorrhage (11%), Third or fourth degree tears, Uterine rupture.

Question 7

Red flags?

Answer 7

Slow emergence of face and chin, Head remaining tightly applied to vulva, no nape of the neck visible , Head retracts depressing the perineum (turtle-neck sign), Head does not restitute, Anterior shoulder does not descend with maternal effort and/or when routine axial traction is applied.

Question 8

What should be done?

Answer 8

Stop pushing
McRoberts
Suprapubic Pressure
?Episiotomy

Question 9

Internal manoevers?

Answer 9

Pringle fingers - move post arm
pressure to anterior aspect of posterior shoulder (Suprapubic pressure)
Apply pressure to posterior aspect of posterior shoulder no suprapubic press
Slide hand up to posterior aspect of anterior shoulder and apply pressure here.

Question 10

If nothing works?

Answer 10

All fours and internal manoeuvres

Zavanelli manoeuvre
Symphysiotomy
Cleidotomy