Shoulder dystocia

Question 1

What is shoulder dystocia?

Answer 1

Impaction of anterior fetal shoulder on maternal pubic symphis.

A delivery requiring additional obstetric manoeuvres to release the shoulders after gentle downward traction has failed

Question 2

What is shoulder dystocia associated with?

Answer 2

• Large/postmature foetus (macrosomia)
• BMI > 30
• Induced/oxytocin augmented labour
• Prolonged 1st/2nd stage
• Secondary labour arrest
• Assisted vaginal delivery (forceps, ventose, assisted)
• Previous dystocia
• DIabetes

Question 3

What complications occur in shoulder dystocia?

Answer 3

• Maternal
  
  • PPH
  • 4th degree tears
• Foetus
  
  • Brachial plexus injury (typically erb’s)
  • Fractured clavicle
  • Hypoxic-ischaemic-encpehalopathy
  • Death

Question 4

What nerve injury can occur from shoulder dystocia?

Answer 4

Erb’s palsy

Question 5

What is the main danger to the baby if shoulder dystocia occurs?

Answer 5

Asphyxia

Question 6

How would you manage shoulder dystocia?

Answer 6

Helper

• Get Help
• Episiotomy
• Legs - McRoberts maneuver (hyperflexing maternal thighs onto abdomen)
• Suprapubic Pressure
• Enter maneuvers/(internal rotation of anterior shoulder)
• Remove posterior arm from the birth canal
• Roll - onto all 4s

Question 7

What should you do following the delivery of the baby with shoulder dystocia?

Answer 7

• Record time of delivery of head
• Direction of head after restitution
• Record manoeuvres
• Record time of delivery of body
• Apgar of baby at birth