Shoulder Dystocia

Question 1

what is shoulder dystocia?

Answer 1

• a complication of vaginal cephalic delivery

- inability to delivery body of fetus using gentle traction, the head having already been delivered

Question 2

what is shoulder dystocia associated with?

Answer 2

• maternal morbidity (PPH, perineral tears)
• fetal morbidity (brachial plexus injury)
• neonatal death

Question 3

what are the risk factors for shoulder dystocia?

Answer 3

1. fetal macrosomia
2. high maternal BMI
3. DM
4. prolonged labour

Question 4

how does shoulder dystocia usually occur?

Answer 4

impaction of the anterior fetal shoulder on the maternal pubic symphysis

Question 5

what should be done as soon as shoulder dystocia is identified?

Answer 5

call for help

perform McRoberts’ manouevre

Question 6

what is the McRoberts’ manouevre?

Answer 6

flexion and abduction of the maternal hips, bringing mother’s thighs towards her abdomen

this increases the relative anterior-posterior angle of the pelvis and often facilitates a successful delivery

Question 7

A neonate is born at 38 weeks gestation via spontaneous vaginal delivery. The birth weight was 4.5kg. In the newborn postnatal check the attending doctor notes that there is adduction and internal rotation of the right arm. What is the most likely diagnosis?

Answer 7

Erb’s palsy

occurs due to damage to the upper brachial plexus most commonly from shoulder dystocia.

Damage to these nerve roots results in a characteristic pattern: adduction and internal rotation of the arm, with pronation of the forearm. This classic physical position is commonly called the ‘waiter’s tip’.