Shoulder Dystocia Flashcards
What is shoulder dystocia?
Shoulder dystocia is an obstetric emergency where the fetal shoulders fail to deliver after the head, usually due to impaction behind the maternal pelvis.
What is the primary cause of shoulder dystocia?
It is caused by impaction of the anterior fetal shoulder behind the maternal pubic symphysis or, less commonly, the posterior shoulder on the sacral promontory.
What are the risk factors for shoulder dystocia?
Risk factors include macrosomia, maternal diabetes, obesity, prolonged second stage of labour, instrumental delivery, and previous shoulder dystocia.
What is macrosomia?
Macrosomia refers to a fetus with an estimated weight of >4 kg, increasing the risk of shoulder dystocia.
What are the potential complications of shoulder dystocia for the baby?
Complications include brachial plexus injury, clavicle or humerus fracture, hypoxia, and, in severe cases, neonatal death.
What are the potential complications of shoulder dystocia for the mother?
Maternal complications include postpartum haemorrhage, perineal tears, uterine rupture, and psychological trauma.
How is shoulder dystocia diagnosed?
It is diagnosed when the head delivers but the shoulders fail to follow despite gentle traction, often noted by the “turtle sign.”
What is the “turtle sign” in shoulder dystocia?
The “turtle sign” is the retraction of the fetal head against the perineum after delivery of the head, indicating shoulder dystocia.
What is the immediate management of shoulder dystocia?
Management involves calling for help, stopping active pushing, and performing specific manoeuvres to release the impacted shoulder.
What is the McRoberts manoeuvre?
The McRoberts manoeuvre involves flexing the mother’s hips and knees towards her chest to widen the pelvic outlet.
What is suprapubic pressure, and how is it used?
Suprapubic pressure is applied to the anterior shoulder to help dislodge it from behind the pubic symphysis.
What is the Rubin manoeuvre?
The Rubin manoeuvre involves inserting a hand into the vagina and applying pressure on the posterior aspect of the anterior shoulder to rotate it.
What is the Woods screw manoeuvre?
The Woods screw manoeuvre involves applying pressure to both the anterior and posterior shoulders to rotate the baby and facilitate delivery.
What is the role of delivery of the posterior arm in shoulder dystocia?
Delivering the posterior arm reduces the diameter of the fetal shoulders, allowing for easier delivery.
What is the Zavanelli manoeuvre?
The Zavanelli manoeuvre involves cephalic replacement of the fetal head followed by an emergency caesarean section.
When is the Zavanelli manoeuvre used in shoulder dystocia?
It is a last-resort manoeuvre when other techniques fail to resolve the dystocia.
How can episiotomy assist in managing shoulder dystocia?
Episiotomy provides more space for internal manoeuvres but does not directly resolve the impaction.
What are the key steps in managing shoulder dystocia?
The key steps include McRoberts manoeuvre, suprapubic pressure, Rubin or Woods screw manoeuvres, and delivery of the posterior arm.
What is the role of a multidisciplinary team in managing shoulder dystocia?
The team includes obstetricians, midwives, neonatologists, and anaesthetists to ensure maternal and neonatal safety.
What neonatal injuries are associated with shoulder dystocia?
Injuries include Erb’s palsy (brachial plexus injury), clavicle or humerus fractures, and hypoxic-ischaemic encephalopathy.
How can shoulder dystocia be prevented in high-risk pregnancies?
Prevention involves identifying risk factors, considering elective caesarean for macrosomia, and careful monitoring during labour.
What is the prognosis for brachial plexus injuries caused by shoulder dystocia?
Most resolve within 6–12 months, but some may result in permanent neurological deficits.
What are the maternal psychological effects of shoulder dystocia?
Mothers may experience anxiety, fear, or post-traumatic stress disorder (PTSD) after a shoulder dystocia event.
What documentation is important after a shoulder dystocia event?
Detailed documentation of the sequence of events, manoeuvres performed, time intervals, and any complications is crucial.
How should women with a history of shoulder dystocia be managed in subsequent pregnancies?
They should receive counselling, careful antenatal assessment, and individualised delivery planning, including the option of elective caesarean.
