Shoulder Dystocia

Question 1

Pre-labour risk factors for shoulder dystocia?

Answer 1

Pre-labour
Previous shoulder dystocia
Macrosomia
Gestational age
Maternal diabetes mellitus
Maternal obesity

Question 2

Intrapartum risk factors for shoulder dystocia?

Answer 2

Prolonged first stage
Prolonged second stage
Labour augmentation
Instrumental vaginal birth

Question 3

Algorithm for management of shoulder dystocia

Answer 3

1. Call for help
2. McRobert’s manoeuvre (thighs to abdomen)
3. Suprapubic pressure and routine axial traction
4. Consider episiotomy if unable to gain access with whole hand
5. Deliver posterior arm
   or
6. Internal rotational manoeuvres
7. Inform consultant obstetrician and anaesthetist
8. If all above fail to release impacted shoulders consider the following:
   All-fours position
   or
   REPEAT ALL ABOVE AGAIN
   Then consider cleidotomy, Zavanelli manoeuvre or symphysiotomy

Question 4

Signs of shoulder dytocia

Answer 4

• Difficulty with birth of face or chin
• When the head is born, it remains tightly applied to the vulva
• The chin retracts and depresses the perineum (turtle neck sign)
• The anterior shoulder fails to release with maternal effort and/or when routine axial traction is applied

Question 5

Who is often forgotten to be called in a shoulder dystocia emergency?

Answer 5

Neonatologist or paediatrician

Question 6

In a pool birth scenario, what should the midwife do on recognition that there is a delay in the birth of the shoulders?

Answer 6

Ask the woman to get out of the pool on recognition and do not attempt any manoeuvres in the pool

Question 7

What is the reported success rate of the McRoberts’ manoeuvre?

Answer 7

Reported as high as 90% but recent data suggests less than 50%