EM: Shoulder Dystocia

Question 1

what is shoulder dystocia?

Answer 1

fetal head delivers but shoulders get stuck behind the pubic symphysis

Question 2

when should shoulder dystocia be suspected?

Answer 2

• unable to deliver the anterior shoulder
• fetal head delivers but is tightly applied to the vulva
• chin retracts and depresses the perineum
• head fails to deliver with normal manoeuvres

Question 3

what is the emergency mx for shoulder dystocia?

Answer 3

1. call for help
2. place mother on edge of the bed
3. communicate with the pt that co-operation is required

Question 4

what manoeuvre can be done in a case of shoulder dystocia?

Answer 4

McRobert’s
- hyperflex the hips and support knees
- abduct and rotate legs outwards

= maximal AP diameter possible
= symphysis more horizontal to facilitate shoulder delivery

Question 6

anterior shoulder interventions

Answer 6

> supra-pubic pressure using heel of hands