Shouder Dystocia Flashcards
Define shoulder dystocia
After delivery of the head, the anterior shoulder of the infant cannot pass the pubic symphysis
Risk factors for Shoulder Dystocia
- Previous shoulder dystocia
- Diabetes
- Long labour
- Large foetus
- Asisted vaginal birth/forceps
Major foetal complications
- Brachial plexus plasy
- Erb’s palsy - paralysis of affected arm
- Hypoxia or neurological injury - CP
- Fracture of clavicle/humerus
Major maternal complications
- PPH
2. Genital tract trauma
Mechanism that goes wrong in shoulder dystocia
Failure of internal rotation
Shoulder dystocia Mx ( 1st )
Call for help
Shoulder dystocia Mx ( 2nd )
Evaluate for episiotomy
Shoulder dystocia Mx ( 3rd )
Legs - Mc Robert’s manouvre causing hyperflexion of maternal legs
Shoulder Dystocia Mx (4th )
Pressure - apply suprapubic pressure
Shoulder dystocia Mx (5th )
Enter pelvis for internal rotational manouvres
- pressure on posterior aspect of anterior shoulder to adduct and rotate
- Wood’s screw - pressure on anterior aspect of posterior shoulder
Shoulder dystocia Mx (6)
Remove posterior arm
Shouder dystocia Mx (7)
Roll patient onto her knees
Acronym for Shoulder dystocia Mx
HELPERR
What is Erb’s palsy?
Damage to nerve roots C4, C5 and C6 leading to paralysis of the arm
How is shoulder dystocia managed?
Do not pull on the head - leads to damage of brachial plexus
Lie patient flat and try following steps until they work:
Put them in McRoberts position, if this does not work then
Apply suprapubic pressure to dislodge and deliver anterior shoulder, if this does not work then
Use internal rotation techniques to try and rotate anterior shoulder from under pubic symphysis
Deliver posterior arm
