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Shoulder Dystocia

This document discusses shoulder dystocia, which occurs when a baby's shoulders get stuck after the head is delivered during childbirth. It defines shoulder dystocia and discusses its incidence, consequences, and risk factors. The document outlines several management techniques to address shoulder dystocia, including gentle downward traction, obstetric maneuvers like the McRoberts maneuver and suprapubic pressure, and potentially reducing the bisacromial diameter through maneuvers like Rubin I, Rubin II, or the Wood's screw. It emphasizes preparing for potential shoulder dystocia, calling for help, staying calm, and properly documenting any maneuvers used to resolve the issue.

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norma
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592 views39 pages

Shoulder Dystocia

This document discusses shoulder dystocia, which occurs when a baby's shoulders get stuck after the head is delivered during childbirth. It defines shoulder dystocia and discusses its incidence, consequences, and risk factors. The document outlines several management techniques to address shoulder dystocia, including gentle downward traction, obstetric maneuvers like the McRoberts maneuver and suprapubic pressure, and potentially reducing the bisacromial diameter through maneuvers like Rubin I, Rubin II, or the Wood's screw. It emphasizes preparing for potential shoulder dystocia, calling for help, staying calm, and properly documenting any maneuvers used to resolve the issue.

Uploaded by

norma
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Abdulkareem Fayoumi

 Definition .

 Incidence .

 Consequences .

 Risk factors .

 Management.
 A head-to-body delivery time > 60 seconds due
to impaction of the shoulder ( anterior )against
the symphsis pubis.
Williams Ob

 Use of any of the obstetric maneuvers to


release the shoulder after gentle downward
traction has failed.
RCOG ,2005
 Mean time of N delivery  24 sec.

 Mean time of delivery with dystocia  79 sec.


 0.6 – 1.4 % ( defenition,population and
weight ).
 An obstetric emergency.

 Increased maternal morbidity.

 Increased fetal morbidity & mortality .


 PPH ; 11 %
- atony
-soft tissue trauma ; 3rd & 4th degree tears 3.8%

 Symphyseal diathesis ( rare )

 Uterine rupture ( rare )


 Fetal injury ;
- brachial plexus injury 4-16 % .
- fractures of clavicle and humerus .

 Fetal hypoxia ;
- neurological damage .
- death .
Brachial plexus injury

4-6 % .
Due to downward traction on the neck .
Most important fetal effect .
Most common cause for litigation in SD .
Independent of operator experience .
GOOD NEWS >80 % of cases have complete
resolution by 6-13 months.
 Maternal :  Fetal :
previous SD.

Obesity. Macrosomia

Multiparity.
postdate.
DM.

short stature. IUFD

abN pelvic anatomy. Instrumental delivery


NO BUT there is a room

for prediction & anticipation.


 Good glycmic control.

 Control weight gain.

 Identifying risk factors.


>50 % of SD cases occur with average weight

Babies < 4 kg !!!

so always be ready…

unpredictable ..unpreventable
 Prepare :

 educate/involve the ptn ahead of delivery.


 declutter the room .
 senior person .
 empty the bladder .
 STAY CALM !!!
 HELPERR
 Each step 30-60 Sec

 For a total 3- 5 minutes (All Maneuvers)

 No indication that any of these maneuvers is


superior, they represent a valuable tool to
help clinicians take effective steps to relieve
impacted shoulder ( Category C )

ACOG..October 1997
1. Increase the size of the bony pelvis

2. Decrease bisacromial diameter

3. Change the relation of bisacromial diameter


within the bony pelvis .
 Prolonged 1st & 2nd stage of labor.

 Head bobbing ( turtle sign ), then retracting


back in the birth canal.

 Minimal downward traction does not affect


delivery.
 Do NOT ask the patient to push.

 Do NOT apply fundal pressure. ( Grade C )

 Do NOT panic !!

RCOG guidelines..December,2005
Call for help
SD drill..team work.

documentation.
Evaluate for

Episiotomy
Not for all cases ( Grade B )

Before delivery.

Helps when applying the maneuvers


RCOG guidelines December,2005
Legs ( McRobert’s )
Safe
Simple
Effective ( used alone resolves 40 % of SD )
•Straighten the sacrum.

•Moves the symphsis pubis toward the maternal


head frees the impacted shoulder
Suprapubic Pressure
determine the position of the fetal back

Initially..continuous

Then..in CPR-like rocking motion.


Enter=internal
Maneuvers :

Rubin
Wood’s Screw
 Rubin I :
rocking the fetus shoulder from side to side.

 Rubin II :
reach for the most easily shoulder &
push it forward decrease the
bisacromial diameter .
 Rotate the posterior shoulder 180 degrees

approach
post. Shoulder from front.
ant. Shoulder from behind.
 Reverse wood’s screw

posterior shoulder from behind.


Remove the posterior
Arm
Never grasp / pull on the hand 

fractures
Roll the patient
•Might be disorienting for the unfamiliar doctor

•Increase the obstetric conjugate by 1.5 cm

•Gravity?? Movement itself??

•Same maneuvers can be applied


 Deliberate clavicular fracture.

 Zavenilli maneuver. (tocolysis,replace head->CS )

 Symphysiolotmy. ( risk of UT/SP injury )

 Cleidotomy. ( with a dead fetus )

 Abdominal surgery + hysterotomy ( case


reports,same maneuvers )
 Always be ready and calm while dealing with
SD.

 Know your HELPERR

 Always document ( time , manuevers used,


duration, involved arm )
Now …we will move to practice plz!!

Thank you!!

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