Shoulder Dystocia

Question 1

RISK FACTORS:

Answer 1

1. Macrosomia
   - only 50% cases in babies >4kg
2. Diabetes
3. High maternal BMI
4. Previous shoulder dystocia
5. IOL
6. Low height
7. Instrumental delivery
8. Prolonged labour
9. Male fetus

Question 2

MANAGEMENT:

Answer 2

1. McRobert’s manoeuver with application of suprapubic pressure
2. Episiotomy for internal manoeuvers
   - Wood’s screw manoeuver
   - deliver posterior arm
3. Fracture one or both clavicles(cleidotomy)
   - To reduce the bisacromial distance
4. Symphysiotomy
   - Metal catheter to displace urethra
5. Zavanelli manoeuver
   - Replacement of head and C-section

Question 3

COMPLICATIONS:

Answer 3

1. Increases:
   a) Fetal morbidity: brachial plexus injury
   b) Maternal morbidity: PPH, perineal tears

Question 4

HELPERR

Answer 4

H: Call for help
- further midwives, obstetrician, SCBU, anaesthetist
E: Evaluate for episiotomy
L: Legs to McRoberts position
P: Pressure suprapubically
E: Enter(Internal rotation into oblique diameter of pelvis)
R: Remove posterior arm
R: Roll over to all fours