Should dystocia

Question 1

prevalence shoulder dystocia

Answer 1

3%

Question 2

Risk factors SD

Answer 2

• increasing birth weight
• maternal diabetes
• pitocin
• prior SD (reoccurrence risk 5-10%)
• operative vaginal delivery

Question 3

maternal complications of SD

Answer 3

• 4th degree tears
• hemorrhage
• cutaneous neuropathy
• obstetrical anal sphincter injury

Question 4

neonatal complications of SD

Answer 4

• brachial plexus injury (5% incidence with 80% recovery)
• clavicular humerus fracture
• neonatal asphyxia

Question 5

SD prevention with iOL prior to 39w

Answer 5

not recommended

Question 6

NND with CS to prevent one permanent neonatal nerve injury in a diabetic mother at 4500g

Answer 6

400

Question 7

management of SD

Answer 7

1. mcroberts
2. suprapubic pressure (avoid fundal pressure)
3. Delivery of posterior arm

95% cases resolved with above

4. Rotation maneuvers
   - rubin maneuver : pressure on posterior shoulder
   - Wood screw; pressure on anterior shoulder
   - gaskin ‘all fours with gentile traction
5. Zavanelli
6. Abdominal rescue (intraabdominal pressures anterior shoulder)

Question 8

SD sims have shown improvement in

Answer 8

communication
above maneuvers
documentation of delivery