shoulder dystocia

2. C.MADHUBALA
MSC NURSING
DEPT OF OBG

3. The term shoulder dystocia is defined to describe a
wide range of additional obstetric maneuvers to
deliver the fetus after the head has been born and
gentle traction has failed to deliver the shoulder.
Shoulder dystocia occurs when either the anterior
or the posterior (rare) fetal shoulder impacts on the
maternal symphysis or on the sacral promontory
respectively.

4. Overall incidence varies between 0.2% and 1%.

5.  Previous shoulder dystocia
 Macrosomia
 Diabetes
 Obesity
 Induced labor
 Prolonged first stage or second stage of labor
 Postmaturity
 Multiparity
 Anencephaly
 Fetal ascites

6.  Turtle neck sign
 Inadequate spontaneous restitution
 Fetal face becomes plethoric
 Failure of shoulder to descend.

8.  Clear infant’s mouth and nose
 Not to give traction over baby’s head
 Never apply fundal pressure as it causes further impaction
of the shoulder
 To perform wide mediolateral episiotomy as it provides
space posteriorly
 To involve the anesthetist and the pediatrician

9. Manuevers to be followed
 McRoberts maneuver
 Wood’s maneuver
 Extraction of the posterior arm
 “All Fours” Position

10. This straightens the lumbosacral angle, rotates the
maternal pelvis upward and increases the anterior-
posterior diameter of the pelvis. This maneuver is
effective and is successful in about 90% of cases.

12. This pushes the bisacromial diameter from the
anteroposterior diameter to an oblique diameter.
This helps easy entry of the bisacromial diameter
into the pelvic inlet.

14. The operator’s hand is introduced into the vagina
along the fetal posterior humerus in the sacral
hollow. The arm is then swept across the chest and
thereafter delivered by gentle traction.

16. Downward traction on the posterior shoulder helps to
free the impacted shoulder

19.  Cleidotomy
 Zavanelli maneuver
 Symphysiotomy

20. Fetal
 Asphyxia
 brachial plexus injury (plexopathy) ,
 Erb and Klumpke palsy,
 humerus fracture,
 clavicle or sternomastoid hematoma during
delivery.
 Perinatal morbidity and mortality are high.

23. Maternal:
 PPH (11%)
 cervical laceration
 vaginal tear
 perineal tear
 rupture of uterus, bladder
 sacroiliac joint dislocation
 morbidity

24.  Risk of maternal injury related to mechanical obstruction
of fetal descent.
 Risk for fetal injury related to tissue hypoxia or fetal
malpresentation
 Acute pain related to related to uterine contractions or
position of the fetus
 Risk for infection related to rupture of membrane
 Anxiety related to concern of self and fetus
 Risk for fluid volume deficoit related to vomiting or
restricted oral intake.
 Ineffective individual coping related to personal
vulnerability