SHOULDER DYSTOCIA

Question 1

What is the golden time for managing shoulder dystocia?

Answer 1

5 minutes. Beyond this, the fetus is prone to hypoxia and injury.

Question 2

What is the incidence of shoulder dystocia?

Answer 2

0-1.3%.

Question 3

What is the hallmark sign of shoulder dystocia?

Answer 3

Turtle’s sign.

Question 4

What occurs during shoulder dystocia?

Answer 4

The anterior shoulder becomes obstructed by the maternal pubic bone after the head is delivered.

Question 5

What are potential fetal complications of shoulder dystocia?

Answer 5

Fetal asphyxia, brachial plexus injury, and clavicular fracture.

Question 6

What are risk factors for shoulder dystocia?

Answer 6

Previous history, macrosomia, maternal diabetes, obesity, prolonged labor, and narrow pelvis.

Question 7

What fetal weight is considered macrosomia in diabetic mothers?

Answer 7

Greater than 4 kg.

Question 8

What fetal weight is considered macrosomia in non-diabetic mothers?

Answer 8

Greater than 4.2 kg.

Question 9

What should be avoided during shoulder dystocia management (4Ps)?

Answer 9

Pulling, pushing, panicking, and pivoting the head.

Question 10

What does the acronym HELPERR stand for in shoulder dystocia management?

Answer 10

H: Help, E: Evaluate for episiotomy, L: Legs (McRoberts maneuver), P: Pressure (suprapubic), E: Enter (rotational maneuvers), R: Remove the posterior arm, R: Roll the patient to hands and knees.

Question 11

What does the acronym ALARMER stand for in shoulder dystocia management?

Answer 11

A: Ask for help, L: Lift/hyperflex (McRoberts), A: Anterior shoulder disimpaction, R: Rotate posterior shoulder, M: Manual removal of posterior arm, E: Episiotomy, R: Roll into all fours.

Question 12

What is the purpose of the McRoberts maneuver?

Answer 12

To increase the pelvic diameter and change the angle of the birth canal to dislodge the shoulder.

Question 13

How is suprapubic pressure applied to manage shoulder dystocia?

Answer 13

By pressing down on the pubic bone to help dislodge the anterior shoulder.

Question 14

What maneuver is used for anterior shoulder disimpaction?

Answer 14

Mazzanti maneuver or Rubin’s maneuver.

Question 15

What maneuver is used for posterior shoulder rotation?

Answer 15

Wood’s or Screw maneuver.

Question 16

What is the Gaskin maneuver?

Answer 16

The mother is placed on all fours to increase pelvic diameter and relieve pressure on the shoulders.

Question 17

What is the Zavanelli maneuver?

Answer 17

Cephalic replacement by reversing the cardinal movements of labor followed by cesarean delivery.

Question 18

What are the cardinal movements of labor (ED FIRERE)?

Answer 18

Engagement, Descend, Flexion, Internal Rotation, External Rotation, Extension.

Question 19

What should be done if all maneuvers fail to resolve shoulder dystocia?

Answer 19

Deliberate fracture of the clavicle, symphysiotomy, or Zavanelli maneuver followed by cesarean delivery.

Question 20

What are maternal complications of shoulder dystocia?

Answer 20

Postpartum hemorrhage, uterine rupture, and trauma from maneuvers.

Question 21

What percentage of shoulder dystocia cases lead to postpartum hemorrhage?

Answer 21

11%, due to uterine atony and lacerations.

Question 22

What are neonatal complications of shoulder dystocia?

Answer 22

Hypoxia, brachial plexus injury, clavicular fracture, and increased neonatal morbidity.

Question 23

How is the third stage of labor managed after shoulder dystocia?

Answer 23

Actively manage the stage, conduct cord blood gas analysis, and ensure neonatal resuscitation.

Question 24

Why is timely and accurate documentation important in shoulder dystocia?

Answer 24

To prevent litigation and ensure proper medical records.

Question 25

What team members should be called during a shoulder dystocia emergency?

Answer 25

Obstetrician, pediatrician, anesthesiologist, and nursing staff.

Question 26

What does the McRoberts maneuver specifically do to help manage shoulder dystocia?

Answer 26

It flattens the sacrum and increases the pelvic inlet space to help dislodge the shoulder.

Question 27

What is the function of suprapubic pressure in shoulder dystocia?

Answer 27

To dislodge the anterior shoulder from behind the pubic bone.

Question 28

What is Rubin's maneuver?

Answer 28

Adduction of the most accessible shoulder to move the fetus into an oblique position and reduce the bisacromial diameter.

Question 29

What is the Wood's screw maneuver?

Answer 29

Abduction of the posterior shoulder by exerting pressure on the anterior surface of the posterior shoulder.

Question 30

What is the purpose of manual rotation of the posterior arm in shoulder dystocia?

Answer 30

To rotate the posterior shoulder and allow it to emerge more easily.

Question 31

When is the Gaskin maneuver most effective?

Answer 31

When other maneuvers have failed, as it increases pelvic diameter and changes the angle of the birth canal.

Question 32

What is a potential last-resort solution for shoulder dystocia?

Answer 32

Deliberate fracture of the clavicle to reduce shoulder width.

Question 33

What is symphysiotomy, and when is it performed?

Answer 33

It is the surgical division of the pubic symphysis, performed in extreme cases of shoulder dystocia.

Question 34

What are strategies to prevent shoulder dystocia?

Answer 34

Regular prenatal monitoring, early identification of macrosomia, and elective cesarean delivery in high-risk cases.

Question 35

What are the common maternal risk factors for shoulder dystocia?

Answer 35

Obesity, diabetes, narrow pelvis, and history of prolonged labor.

Question 36

What is the pathophysiology of shoulder dystocia?

Answer 36

The anterior shoulder becomes lodged against the maternal pubic bone, obstructing delivery.

Question 37

Why is neonatal resuscitation critical after shoulder dystocia?

Answer 37

To address potential hypoxia and birth injuries sustained during delivery.

Question 38

How does obesity increase the risk of shoulder dystocia?

Answer 38

By altering pelvic dimensions and adding fatty tissue that impedes fetal descent.

Question 39

What is the importance of prenatal counseling for shoulder dystocia?

Answer 39

To prepare parents for potential complications and reduce anxiety.