Shoulder dystocia

 Obstetric emergency where after

delivery of the head, the anterior shoulder
of the infant fails to pass below the
symphysis
 Failure of the shoulders to traverse pelvis
spontaneously after birth of head
 The anterior shoulder becomes trapped behind or on
symphysis pubis
 While posterior shoulder may be in hollow of the
sacrum or high above sacral promontory
 Traction will impact anterior shoulder, impending
attempts at delivery
 Pre-gestation& gestational diabetes
 Fetal macrosomia
 Maternal obesity
 Fetalmacrosomia major risk (not
predictable)
 History of large siblings
 Excessive maternal weight gain
 Fetus of the male gender
 Maternal risk factors include;
 Being over age of 35 years
 Being short in stature
 Small or abnormal pelvis
 Post-term pregnancy
 Multiparity
 Previousshoulder dystocia (common
with increased maternal age, obesity &
multiparity
 Warning signs
 Prolonged or arrested first or active stage of
labour
 Prolonged descend of fetal head or failure
 Need for oxytocin to stimulate contractions
 Turtle sign
 Protracted second stage of labour
 Absence of shoulder rotation or descent
 Turtle sign: fetal head appears & retracts
 Definite recoil of the head back against
perineum
 Fetal head remains tightly applied to
vulva
 Chin retracts and depresses the perineum
 No restitution
 Baby ‘s face is erythematous and puffy
 Help
 Episiotomy
 Legs in McRobert position
 Pressure suprapubically
 Enter vagina (internal rotation)
 Remove posterior arm
 Roll the woman over and try again
 Change in maternal position
 McRoberts Manoeuvre
 Supra pubic pressure
 All fours position(gaskin manoeuvre)
 Position of mother
 Episiotomy
 Delivery of the posterior arm
 Rubin ‘s manoeuvre
 Wood’s manoeuvre
 Symphysiotomy
 Follow and study procedure on page
506-510
(Sellers;2018)
 Prepare for resuscitate severe asphyxiated
baby
 Call paediatrician (hospital delivery)
 If baby not breathing, initiate basic
emergency resuscitation via bag and
mask
 Perform physical examination to rule out
injuries
 Nurse in high care ward(neonatal unit)
 Allow mother to see and hold baby
 Document all activities (type of
manoevre used)
 Store CTG tracing in file
 Write incidence report
 Document all resuscitation efforts
 Maternal complications
 Increased incidence of PPH
 Uterine rupture
 Perineum lacerations & extensions of
episiotomy
 Risk of postpartum infection
 Temporary postpartum bladder atony
 Damage to lateral femoral cutaneous
nerve
 Separation of maternal symphyseal joint
 Fetal complications
 Fetal injury (brachial plexus injury)
 Fetal death
 Fetal asphyxia
 Fetal hypoxia resulting in cerebral palsy
 Damage to the upper brachial plexus
nerves (klumpke & Erb’s Palsy