Shoulder Dystocia

Question 1

What is the timeframe in which a baby must be delivered in a shoulder dystocia?

Answer 1

5-7 minutes, due to the compression of the cord against the pelvic rim.

Question 2

What management is likely to be required for the newborn after being freed in a shoulder dystocia?

Answer 2

Resuscitation, potential clavicle/other fracture Mx.

Question 3

During shoulder dystocia manoeuvres, be prepare for a sudden…?

Answer 3

release of resistance, and be prepared to take hold of the baby.

Question 4

What are the 8 sequential signs listed of a shoulder dystocia?

Answer 4

1. Normal birthing procedure fails to accomplish delivery
2. Prolonged head to body delivery time (>60s)
3. Difficulty with birth of face and chin
4. Baby’s head retracts against perineum (turtle sign)
5. Failure of baby’s head to restitute
6. Failure of shoulders to descend
7. Difficulty reaching neck for cord check
8. Baby’s head turns purple and then black

Question 5

In a shoulder dystocia, with a prolonged head to body delivery time of >60s, what is the initial Mx?

Answer 5

1. Note time of birth of head
2. Request urgent assistance
3. Explain to mother and ask her to push ++effort
4. Position in lithotomy
5. Apply gentle downward traction to deliver anterior shoulder

Question 6

In a shoulder dystocia, if initial management initiated unsuccessfully and delivery does not occur after 30-60s, what is the sequence to follow?

Answer 6

McRobert’s (knees to nipples) 30-60s
Suprapubic pressure (while in McRobert’s) 30-60s
Gaskins 30-60s

Continue to repeat, note times and consult with PIPER for when to abandon manoeuvres.

Question 7

Describe McRobert’s manoeuvre.

Answer 7

Hyperflexion of the maternal hips - knees to nipples.

1. Place mother in recumbent position.
2. Hips to the edge of the bed for better traction.
3. Assist mother to grasp her knees and pull knees/thighs back as far as possible onto her abdomen.
   - Use assistant where available.

Question 8

Describe suprapubic pressure.

Answer 8

While in McRobert’s position:

• Hands in CPR position behind symphysis pubis, at 45 degree angle along baby’s back (trying to rotate baby forward)
• Apply 30s firm downward pressure, then 30s rocking motion to try and get baby out from under rim at a rate of approx. 1 per second.

Question 9

Describe Gaskin’s manoeuvre.

Answer 9

Rotate mother to all fours.
Hold baby’s head and apply gentle downward traction, trying to dis-impact and deliver the posterior shoulder (now uppermost)

Question 10

What is the STOP note in the shoulder dystocia guideline, in regards to manipulating the baby?

Answer 10

At no time attempt to rotate the baby’s head. Instead, rotate shoulders using pressure on the baby’s scapula instead.