Shoulder Dystocia

Question 1

Definition

Answer 1

Obstructed labour where following the delivery of the head the anterior shoulder becomes obstructed behind the maternal pubic symphysis

Question 2

Risk factors

Answer 2

Macrosomia
Maternal GDM
Maternal High BMI
Small pelvis/ stature
Overdue (late gestation)
Previous shoulder dystocia

Question 3

Presentation

Answer 3

Difficult delivering foetal head - “turtle neck sign”
Abdnormal CTG = Foetal distress
Failure of restitution
Failure of descent of foetal shoulders following delivery of head
Prolonged labour

Question 4

Management

Answer 4

Help - Call for help immeadiately
E - Episiotomy
L - Legs in Mc-Roberts position
P - Pressure on suprapubic region to encourage baby down
E - Enter pelvis
R - Rotational manouvre (Woods screw, Rubin)
R - Remove posterior arm
R - Replace head and conduct Zevonelli

Question 5

Maternal Complications

Answer 5

PPH
Perineal tears
Trauma

Question 6

Foetal Complications

Answer 6

Foetal hypoxia
Brachial plexus injury