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Introduction

Shoulder Dystocia occurs when one shoulder of the baby lodges against the mothers pubic bone (symphysis pubis) and prevents further progress through the birth canal. 

Read the complete article; Shoulder Dystocia in the Medical Library > Pathophysiology > Obstetrics.

Clinical Presentation
  • Difficulty with birth of  the face and chin
  • The fetal head retracts against the perineum referred to as ‘turtle’ sign
  • Failure of the fetal head to restitute
  • Failure of the shoulders to descend
Exclusion Criteria
Exclusion Criteria
Risk Assessment

Maternal Risk Factors

  • Increasing maternal age
  • Maternal obesity
  • Maternal birth weight
  • Prolonged pregnancy
  • Short stature
  • Previous history of Shoulder Dystocia
  • Gestational Diabetes
  • Post dates (over due)
  • Abnormal pelvic anatomy

Foetal risk factors

  • Suspected Macrosomia (>4.5kg)
  • Protracted active 1st stage of labour
  • Protracted 2nd stage of labour
  • Anomalies (e.g. Hydrocephalus)
  • Conjoined twins
Management
Primary Care
  • Primary Survey
  • Offer continuous support and reassurance
  • Position patient appropriately in a position of comfort (avoid supine positioning due to aortocaval compression)
  • Perform maternal vital sign survey
  • Consider oxygen if indicated as per CPG
Intermediate Care (EMT / Level 2)
Advanced Care (AP)
Critical & Extended Care (CCP, PSO)
  • As per Advanced Care (AP) guidelines
Additional Information
Management of shoulder dystocia
  • McRoberts position is flexion and abduction of the maternal hips, positioning the maternal thighs on her abdomen.
  • Rubin manoeuvre is continuous suprapubic pressure applied in the McRoberts position to improve success rate.
  • Rockin rubin is then adopted in an attempt to deliver the impacted shoulder.
  • The mother is then positioned on all fours (reverse McRoberts) in an attempt to deliver the none impacted shoulder.

Possible complications:

  • Bracheal Plexus Injury
  • Perineal tears
  • PPH
  • Perinatal morbidity and mortality
  • Liaise with obstetrics unit in the metropolitan area, recording all advice on ePCR
  • Liaise with local hospitals in country areas, recording all advice given on ePCR

References
References
Key Terms & Links
Shoulder-Dystocia
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