Shoulder Dystocia

Question 1

Definition and cause

Answer 1

• Vaginal cephalic delivery that requires additional obstetric manoeuvres to deliver the fetus after the head has delivered and gentle traction has failed
• Anterior shoulder impacts against maternal pubic bone
• Brachial plexus injury is important complication
• Time is important as fetal pH falls by 0.04 per minute

Question 2

Risk factors

Answer 2

• Antenatal
  
  • Previous shoulder dystocia
  • Macrosomia
  • Diabetes mellitus
  • Maternal BMI
  • Induction of labour
• Intrapartum
  
  • Prolonged first or second stage of labour
  • Secondary arrest
  • Oxytocin augmentation
  • Assisted vaginal delivery

Question 3

Management of Shoulder Dystocia (remember HELPERRZ)

Answer 3

• Help
• Evaluate
• Legsin McRoberts
• Pressure, external
• Enter the vagina
• Remove/deliver posterior arm
• Roll over to hands and knees
• Zavanelli maneruvre/break clavicle/symphysiotomy if all fails

NB - note time of delivery