Shoulder dystocia

Question 1

Definition

Answer 1

Failure to deliver the shoulders following the head

Question 2

Signs (3)

Answer 2

Chin pulling back onto perineum No external signs of restitution Anterior shoulder fails to deliver following contraction

Question 3

Predisposing factors (7)

Answer 3

Previous shoulder dystocia >4.5kg baby Maternal diabetes, obesity Prolonged first stage Prolonged second stage with augmentation Instrumental vaginal delivery

Question 4

Maternal risks

Answer 4

Trauma vaginal, bladder, bowel, episiotomy Psychological

Question 5

Neonatal risks

Answer 5

Erbs palsy Cerebral palsy from hypoxia Fractures Death

Question 6

Management

Answer 6

Help- get as many as you can: pediatrics, obstetrics, surgeons, anaesthetics Episiotomy if require more room Legs- perform McRoberts Pressure- suprapubic pressure, downward and lateral to push shoulder under pelvic symphysis Enter manouvres Remove the posterior arm by lifting the head anteriorly Roll the woman on all fours

Question 7

Describe McRoberts manouevre

Answer 7

Abduction and acute flexion of the hips Straightens pelvis, maximises diameter, flex fetal spine Apply gentle suprapubic pressure

Question 8

Describe the Rubin 2 manouvre

Answer 8

Approach anterior shoulder from behinf Pressure on scapula to adduct ant shoulder rotate to oblique

Question 9

Reverse woods screw

Answer 9

Approach posterior shoulder from behind Rotate

Question 10

Woods screw

Answer 10

Approach posterior shoulder from anterior Gentle rotation toward symphysis

Question 11

Last resorts for shoulder dystochia

Answer 11

Zavanelli manouevre Clavicle fracture Symphysiotomy

Question 12

What examination must you not forget with episiotomy/repair

Answer 12

Rectal examination–>identify any trauma to rectal mucosa

Question 13

Time to deliver for shoulder dystocia before terrible outcome very likely

Answer 13

7 minutes