Shoulder Dystocia

Question 1

Define shoulder dystocia

Answer 1

A vaginal cephalic deliver that requires additional obstetric manoeuvres to deliver the baby after the head has delivered and gentle traction failed (RCOG 2012)

Question 2

What is the incidence of shoulder dystocia?

Answer 2

Draycott (2016) states that the incidence is 0.6% in the UK.

Question 3

What are some signs and symptoms of a shoulder dystocia?

Answer 3

• Slow delivery on the head
• Neck does not appear
• Chin retracts against the perineum
• No restitution
• No further descent / progress
• Failed routine traction

Question 4

What are some risk factors for shoulder dystocia?

Answer 4

• Previous history of shoulder dystocia
• Macrosomia
• Prolonged 1st and / or 2nd stage
• Oxytocin augmentation
• Assisted vaginal delivery
• Raised BMI

Question 5

What is the immediate management of a shoulder dystocia?

Answer 5

• Communicate with woman re. situation and stop pushing - legs into McRoberts - Emergency buzzer - state OBSTETRIC EMERGENCY - and shoulder dystocia - full obstetric team
• Suprapubic pressure (30 secs, rocking or cont) (rubin |)
• Enter - CONSIDER EPIS - posteriorly into the sacral hollow - rubin || - woodscrew - reverse woodscrew - removal of posterior arm - roll - flip flop - last resort

Question 6

What is the aim of internal manoeuvres?

Answer 6

To move the fetal shoulders out of the narrowest diameter of the mother’s pelvis

Question 7

Explain the Rubin 2 and woodscrew manoeuvre..

Answer 7

Hand inserted into the posterior aspect of the anterior shoulder - then push the shoulder to shift it to a wider diameter. If unsuccessful attempt woodscrew..

Which is hold hand into the vagina, locate the posterior aspect of the anterior shoulder, insert the other hand on the side of the fetal chest and find the anterior aspect of the posterior - attempt 180 degree rotation.. can attempt REVERSE WOODSCREW too

Question 8

How do you attempt to remove the posterior arm?

Answer 8

Insert hand into vagina in front of the fetus
Identify the posterior arm
Grasp the forearm with your fingers and thumb
Sweep the fetal arm over the chest and out of the vagina
Deliver the rest of the body with gentle routine axial traction

Question 9

What is important to remember to document?

Answer 9

Times of: head delivery, recognition of shoulder dystocia, time of escalation, who attended, times of manoeuvres and who by, each shoulder, position of woman, Apgar scores, postnatal information given to parents, neonatal examination at birth.

Question 10

If a shoulder dystocia occurs, what is the woman at increased risk of…

Answer 10

• PPH
• 3rd / 4th degree tear
• Uterine rupture
• Infection
• PN depression / PTSD

Question 11

What does “HELPER” stand for?

Answer 11

Help
End pushing
Legs into mcroberts
P(suprapubic) Pressure
Enter
Roll and refer