Show Notes
Definition: Failure to deliver fetal shoulders with normal downward traction
Why we care: Baby hypoxia, brachial plexus injuries, maternal injuries
Risk factors:
- DM, excessive weight gain in pregnancy, S>D, Large baby
- Hx of shoulder dystocia (~10-15% recurrence)
- Turtling while pushing
Prevention
- No real prevention as SD is very hard to predict
- Offer cesarean delivery if EFW is >5000g and no DM, or >4500g and any type of DM
What do to:
- Step back. If comfortable, can help minimize family interference. Calmly explain what is happening and what the docs are doing.
- Offer to be the Timekeeper. Write down times and what is happening. Announce every 2 minutes.
What you’ll see:
- Prep: Hypothesize shoulder orientation for suprapubic pressure, place stool
- Announce problem- call for help
- Maneuvers - McRobers, suprapubic
- Posterior arm
- Rotational: Wood’s screw, Rubin
- Gaskins- all 4s
- Episiotomy
- Zavanelli
