Macrosima shoulder dystocia

DEFINITION DEFINITION
1 Failure of delivery of shoulders
a fetus that is > 4000 g
regardless of gestational age
1 after Delivery of head, Despite
performing Ordinary obstetric
maneuvers

ETIOLOGY RISK FACTORS

MACROSOMIA
Diabetes mellitus in pregnancy History of shoulder dystocia
Previous macrosomic fetus
Multiparity
2 2 Fetal macrosomia
Prolonged second stage of labor

AND
Maternal obesity Maternal diabetes mellitus
Excessive gestational weight gain Maternal obesity

SHOULDER
DIAGNOSTICS CLINICAL PICTURE
Features of arrested active phase of
> 4000 gn, as estimated by
3 3 labor
ultrasound measurements (e.g.,
fetal abdominal circumference) DYSTOCIA Turtle sign: the fetal head is partially
delivered but retracts against the
perineum

COMPLICATIONS COMPLICATIONS
Maternal Fetal Maternal Fetal
Genital tract lacerations
Postpartum hemorrhage
Birth injuries
Acute respiratory 4 4 Postpartum Hemorrhage
Peroneal laceration
Hypoxic ischemic
encephalopathy
Uterine rupture distress Obstetric anal sphincter Neonatal asphyxia
Protracted or arrested Neonatal injuries Brachial plexus injuries
labor hyperbilirubinemia Symphyseal separation Fracture of clavicle
Neonatal polycythemia
MANAGMENT
PREVENTION The patient should stop bearing down and lie

Individuals with diabetes mellitus in pregnancy

5 5 supine with the buttocks on the edge of the bed.
Perform shoulder dystocia maneuvers like
should achieve adequate glycemic control. McRoberts' Maneuver and Rotational Maneuver
All pregnant individuals should avoid excessive Last-resort options:Fracture of fetal clavicl or
weight gain. Zavanelli maneuver or Symphysiotomy