Shoulder Dystocia

Question 1

Define

The shoulder could be stuck but then eventually it is normally delivered. When does it become shoulder dystocia?

Answer 1

Anterior shoulder stuck behind pubic symphysis

When 2 attempts at delivering the shoulder with normal traction have failed

Question 2

Why is it an emergency?

How many minutes do you have to deliver the baby?

Risk factors:
Prelabour risks
Intrapartum risks

What type of injury could occur to the baby?

Answer 2

The cord is squashed so low oxygen supply

Around 7 minutes

Macrosomia - DM
Small woman
PMH of shoulder dystocia
Induction of labour

Prolonged second stage of labour
Augmentation of labour with oxytocin
Assisted vaginal delivery

Erbs palsy

Question 3

Management:

Manoeuvres - 3 types

+ Pressure on anterior shoulder - suprapubic pressure

Episiotomy!!!

Zavanelli manoeuvres - push baby back in –> emergency CS

Answer 3

McRoberts - hyperflexion of the mother at hips (Bring knees to abdomen) - posterior pelvic tilt

Rubins manoeuvre - put pressure on posterior aspect of anterior shoulder to move

Wood’s screw manoeuvre - moving baby by both shoulders

Question 4

Other manoeuvres:

If the baby was to die prior to the delivery, what can be done to assist delivery?

Answer 4

Cutting through both clavicles (cleidotomy) with strong scissors

Question 5

Complications:

Maternal - 2

Fetal:
- What type of palsy could the baby get?
- What could be fractured upon delivery?
- Additional risk!!

Answer 5

Episiotomy
Tear - 3/4th degree
PPH

Erb’s palsy
Clavicular fracture
Hypoxic brain injury

Question 6

Erb’s Palsy:

How is the position of the arm described?

Answer 6

Described as being in the ‘porter’s tip’ position