Shuolder Dystocia

Question 1

Shoulder dystocia

Answer 1

• disproportion between the biacromial diameter of the fetus and the antero-posterior diameter of the pelvic inlet
• the anterior shoulder of the fetus becoming impacted behind the symphysis pubis .
• Less commonly the posterior shoulder can impact on the maternal sacral promontory.

Question 2

anterior shoulder becomes trapped

Answer 2

behind the pubic symphysis

Question 3

posterior shoulder impact in

Answer 3

hollow of sacrum or
high above the sacral promontory

Question 4

Shoulder dystocia, its emergency case or not

Answer 4

Emergency case bc 47% of babies that died within 5 minutes.

Question 5

Risk factors of shoulder dystocia

Answer 5

1. Fetal macrosomia
2. Obesity
3. Diabetes
4. Mid pelvic instrumental delivery
5. Post maturity
6. Multiparity
7. Anencephaly
8. Fetal Ascites

Question 6

Warning signs and diagnosis for the shoulder ?

Answer 6

1. Uncomplicated initially.
2. Head advanced slowly.
3. chin may have had
   difficulty in sweeping over the perineum
4. Head is delivered , trying to return into the vagina by reverse traction.
5. Diagnosed when maneuver normally by doctor fail to accomplish delivery

Question 7

What’s the name of the signs when the head will go back and the head already delivered?

Answer 7

Turtle neck sign

Question 8

Management Principles
DONTS:

Answer 8

1. Do not be panicky
2. Do not give traction over baby head
3. Do not apply fundal pressure

Question 9

Management Principles
Do 4.

Answer 9

1. Call for extra help
2. Clear the infant mouth and nose
3. Involve the anesthetist and the pediatrician
4. Perform episiotomy if not performed earlier

Question 10

Management Pre procedure steps and consideration : 4

Answer 10

1. Shout for help
2. Explain procedure
3. Follow general principal of basic care and infection prevention
4. Perform episiotomy

Question 11

TTT of shoulder dystocia

Answer 11

H– call for help
E- evaluate for episiotomy
L—legs –McRoberts Maneuver
P- External Pressure –Suprapubic
E—enter ———-rotational Maneuver
R- remove the posterior arm
R—roll the patient to her hands and knees

Question 12

McRoberts’ maneuver

Answer 12

90% successful
1. flexion and abduction of the
maternal hips, positioning the maternal thighs on her
abdomen.
2. straightens the lumbosacral angle, rotates the maternal.
pelvis towards the mother’s head and increases the relative
anterior-posterior diameter of the pelvis.

Question 13

Rubin’s Maneuver

Answer 13

insert a hand into the vagina and apply pressure to the anterior shoulder in the direction of the baby sternum to rotate > The shoulder and decrease the shoulder diameter.

pressure to the posterior shoulder in the direction of the baby sternum.

Question 14

Woods maneuver and what’s the complication of this maneuver?

Answer 14

Insert hand in vagina Grasp the humorous of posterior arm and keep the arm flexed at the elbow ,sweep the
arm across the chest grasp the hand and deliver the entire arm
With one hand on each side of the fetal head apply firm ,continuous traction down word to move the anterior
shoulder under pubic symphysis
…
Humerus bone can be fractur.

Question 15

What’s the maneuver for shoulder dystocia?

Answer 15

1. McRoberts Maneuver
2. Rubin’s Maneuver
3. Woods maneuver
4. cleidotomy
5. symphysiotomy
6. Zavanelli maneuver

Question 16

cleidotomy

Answer 16

surgical division of the clavicle or
bending with a finger

Question 17

symphysiotomy

Answer 17

dividing the anterior fibers of symphyseal ligament.

Question 18

Zavanelli maneuver

Answer 18

Push the baby to the vagina then CS.

Question 19

Complication of the shoulder dystocia

Answer 19

1. significant perinatal morbidity and mortality evenwhen it is
   managed appropriately.
2. Maternal morbidity is increased,
3. postpartum hemorrhage (11%)
4. third and fourth-degree perineal tears (3.8%).
5. Brachial plexus injury (BPI) is one of the most important fetal
   complications of shoulder dystocia,
6. 10% resulting in permanent neurological dysfunction.

Question 20

Risk management

Answer 20

1. All maternity staf should participate in shoulder dystocia training at least annually.
2. Maneuver should be demonstrated in direct view .
3. Higher fdelity training equipment should be used .