Shoulder Dystocia

Question 1

What is shoulder dystocia?

Answer 1

It is when during labour, the head is delivered but the anterior shoulder gets stuck behind the pubis symphysis

Question 2

What is the incidence of shoulder dystocia?

Answer 2

1. In babies >4000g it occurs at 1,7%

2. In babies >4500g it occurs at 10%

Question 3

What are the causes of shoulder dystocia?

Answer 3

1. Macrosomic babies
2. Maternal diabetes
3. Overweight mothers
4. Moms who gain excessive weight during pregnancy
5. Anencephaly

Question 4

What is the true feature of true fetal dystocia?

Answer 4

The baby’s face is cyanosed

Question 5

What are the causes of a delayed delivery of shoulders?

Answer 5

1. True shoulder dystocia
2. Inadequate cervical dilation
3. Abnormally short cord
4. Conjoined twins
5. Interlocking twins
6. Constriction rings
7. Abnormally large abdomen

Question 6

What are the consequences of shoulder dystocia to the mother?

Answer 6

Tears to the perineum and vagina

Question 7

What are consequences of shoulder dystocia on the fetus?

Answer 7

1. Anoxia-death or permanent brain damage can occur or late neuropsychiatry abnormalities
2. Brachial plexus injury
3. Era-Duchenne’s paralysis (leading to paresis or paralysis of the arm)
4. Fractures of the clavicle or the humerus

Question 8

What is the per vent of shoulder dystocia?

Answer 8

We cannot predict majority of them

But with babies >4500g rather do a elective c/s or if vaginal delivery do episiotomy

Question 9

What is the active management of delivery a baby with shoulder dystocia?

Answer 9

1. Place the mom in McRoberts position(lithotomy)

Question 10

What is the classic method of delivery a shoulder dystocia baby?

Answer 10

1. Exert moderate pressure on the fetal head in the posterior direction
   - the doctor places his hands on the two parietal bones of the fetal head
   - assistant places applies Suprapubic pressure

Question 11

What does the McRoberts method look like?

Answer 11

The patient has her hips hyperflexed against her shoulders to enlarge the pelvic inlet

Question 12

What are the other methods to help manage shoulder dystocia?

Answer 12

1. Posterior arm delivery
2. Woods method-two fingers on posterior shoulder and rotate 180
3. Clavicle shoulder
4. Cleidotomy-cutting the clavicle with scissors if the fetus is already dead
5. Zavinelli’s method: the head is pushed back and a C/S is done-not recommended
6. symphysiotomy