Shoulder dystocia

Question 1

Shoulder dystocia
- Definition
- Features

Answer 1

Definition: condition during vaginal delivery where the fetal head has delivered but the shoulders fails to deliver. The impaction most commonly anteriorly at the pubis symphysis.

Features

1. Obstetric emergency
2. “Turtle sign” – backward retraction of the fetal head to the vagina.
3. > 50% of cases are unpredictable
4. Associated with macrosomia (>4500g), prolonged second stage labor and assisted vaginal delivery
5. Majority occur in infants weighing below <4000g

Question 2

Shoulder dystocia

Complications

Answer 2

1. Asphyxia from umbilical cord compression
2. Brachial plexus palsy
3. Limb fracture – due to aggressive manipulations

Question 3

Shoulder dystocia

Management and diagnosis

Answer 3

1. Normal vaginal delivery

a. Anterior shoulder delivery with downward traction followed by upward traction for posterior shoulder – when this fails it is also the diagnosis along with “turtle sign”.

2. First line - McRobert’s maneuver
3. Second line - Wood’s “screw” maneuver
4. Third line – episiotomy