Shoulder Dystocia

Question 1

What are risk factors for shoulder dystocia?

Answer 1

1) macrosomia
2) pregestational and GDM
3) hx shoulder dystocia
4) maternal obesity
5) excessive weight gain in pregnancy
6) multiparity
7) precipitous 2nd stage
8) operative vaginal birth

Question 2

When IS c-section recommended for suspected macrosomia?

Answer 2

1) GDM w/ EFW >/= 4500g

2) no GDM w/ EFW >/= 5000g

Question 3

Describe the steps of shoulder dystocia management

Answer 3

HELPERR

1) call for Help
2) Evaluate for Episiotomy
3) Legs (McRoberts maneuver)
4) subprapubic Pressure
5) Enter (Rubins maneuver to rotate shoulders; woodscrew)
6) Remove posterior arm
7) Roll to hands and knees (Gaskin maneuver)

Question 4

When should rescue maneuvers be considered?

Answer 4

after 5 mins d/t risk of asphyxia

Question 5

What are physical adverse effects for the infant?

Answer 5

• fracture
• brachial plexus injury
• hypoxic ischemic encephalopathy
• death

Question 6

What are physical adverse effects for the parturient?

Answer 6

• PPH
• laceration
• uterine rupture

Question 7

Describe brachial plexus injury

Answer 7

1) Erb’s palsy = flaccid/weak arm d/t damage to C5, C6 nerves
2) Klumpke’s paralysis = paralysis of forearm and hand d/t damage to C8, T1

Question 8

What is the fetal response to hypoxia?

Answer 8

1) transient bradycardia –> decreased oxygen consumption
2) redistribution of blood to vital organs
3) use of anaerobic metabolism

Question 9

How should fetal hypoxia be managed?

Answer 9

1) maternal repositioning
2) reduction of uterine activity
3) IV fluid bolus
4) O2 administration
5) correction of maternal hypotension
6) amnioinfusion
7) alteration of 2nd stage efforts