Shoulder Dystocia

Question 1

What is shoulder dystocia?

Answer 1

When anterior shoulder of fetus gets stuck on pubic symphysis

Question 2

What are risk factors for shoulder dystocia?

Answer 2

Previous shoulder dystocia
Macrosomia
Maternal diabetes
Maternal BMI >30

Question 3

What are features suggestive of shoulder dystocia?

Answer 3

Delay in delivering shoulders following head

Failure of restitution - baby remains facing down

‘Turtle neck’ sign - fetal head retracts back into pelvis

Question 4

How is shoulder dystocia managed?

Answer 4

Call for help

Consider episiotomy

1st line

• McRoberts procedure - maternal knees to chest
• suprapubic pressure

2nd line

• insert hand into vagina and grab posterior arm
• internally rotate fetus

Question 5

What are maternal complications of shoulder dystocia?

Answer 5

3rd/4th degree tear

PPH

Question 6

What are fetal complications of shoulder dystocia?

Answer 6

Humerus/clavicle fracture
Brachial plexus injury
Hypoxic brain injury