Shoulder Dystocia

Dystocia is impaction of the anterior shoulder above the symphysis. It occurs in 1:200 - 1:400 deliveries, or 1.6:100 deliveries if the baby is >4000g.

 

Risk factors include

 

Complications

Maternal complications can include genital tract lacerations, postpartum hemorrhage, or psychological damage

Fetal/neonatal complications include: asphyxia, brachial plexus injury, fractures (clavicle, humerus)

Each baby

 

Management - ALARME

Ask for help: patient to ++ push, nursing to drop head of bed down, anesthesia, pediatrician

Legs: hyperflex legs (MacRobert's manoeuvre) to open pelvis in AP direction

A: Disimpact the anterior shoulder with suprapubic pressure, not fundal presure. Can also try to rotate shoulders to oblique pane by inserting two fingers posteriorly into the vagina and pushing on the front posterior shoulder to move it off the midline

R: release posterior armL find fetal forearm and hand and sweep it across the chest

M: Maneuver of Woods - Corkscrew maneuver

E: epistiotomy

 

Other options include:

deliberate clavicle fracture

Zavenelli maneuver: when head delivers, give short-acting

symphysiotomy: rare