Shoulder Dystocia

A very important obstetric emergency made easy!

 

Lecture by

Video Duration: 7 minutes

  • Shoulder Dystocia
    Created by Helen Bartlett
    General
    Epidemiology

    Shoulder dystocia is the bony impaction of anterior shoulder behind the pubic symphysis (or less commonly the posterior shoulder behind the sacral promontory).

    Pathology

    None

    Top three causes

    Antepartum - maternal diabetes and fetal macrosomia

    Intrapartum - prolonged labour or intervention during labour

    Clinical Features
    Symptoms

    None

    Signs

    Turtle neck sign - the head remains attached tightly to the vulva

    Difficulty delivering the head

    Failure of anterior shoulder to deliver

    Failure of restitution of the head

    Complications - Baby

    • Fetal hypoxia/asphyxia
    • Erbs/Klumpkes palsy
    • Fracture to clavicle

    Complications - Mother

    • Uterine rupture
    • Perineal tears
    • Post-partum haemorhage
    Investigations
    Cultures

    None

    Bloods

    None

    Imaging

    None

    Scopic/Biopsy

    None

    Functional

    None

    Treatment
    Conservative

    'HELPER'

    H - Call for Help, and advise the woman to stop further pushing

    E - Evaluate for an episiotomy

    L - Legs McRoberts position

    P - Suprapubic Pressure - first firmly then rocking fashion

    E - Enter- you may need to enter the vagina (Woods' screw manoeuver)

    R - Reverse Wood screw manoeuvre

    Medical

    None

    Surgical

    None