Shoulder dystocia

Question 0

Shoulder dystocia?

Answer 0

Inability of the fetal shoulders to deliver spontaneously due to the impaction of the anterior shoulder behind the maternal synthesis pubis

Question 1

Patient in labor – head delivers but the shoulders do not: next step? Likely complication? Likely maternal comorbidity?

Answer 1

McRoberts maneuver (hyperflexion of the maternal hips onto abdomen) +/- suprapubic pressure

Postpartum hemorrhage in mother; brachial plexus injury (Erb palsy) in neonate

Diabetes

Question 2

Erb palsy – weakness of what muscles? Nerves?

Answer 2

Deltoid, infraspinatus, flexor muscles of forearm

C5, C6

Question 3

Risk factors for shoulder dystocia?

Answer 3

1. Maternal obesity
2. Fetal macrosomia
3. Prolonged second stage of labor
4. Gestational diabetes

Question 4

When to diagnose shoulder dystocia?

Answer 4

1. External rotation of fetal head is difficult

2. “Turtle sign” – fetal head may retract back toward maternal introitus

Question 5

Other maneuvers for shoulder dystocia (Other than McRoberts maneuver and suprapubic pressure)?

Answer 5

1. Wood’s corkscrew – progressively rotating posterior shoulder in 180° corkscrew fashion
2. Delivery of posterior arm
3. Zavanelli maneuver – Cephalic replacement with immediate cesarean section

Question 6

Type of pressure not to use with shoulder dystocia?

Answer 6

Fundal