This document discusses shoulder dystocia, which occurs when a baby's head is delivered but the shoulders become stuck and cannot be delivered. It defines shoulder dystocia and lists its main causes as a large baby or failure of the shoulders to rotate after delivery of the head. The document then outlines some management techniques for shoulder dystocia, including avoiding excessive pushing, pulling, or pivoting. It provides details on two management types: forceps delivery and ventouse (vacuum) delivery.

1. SCHOOL OF NURSING AND
PARAMEDICAL SCIENCES

2. -PRIYANSHU ANAND
-B.Sc Nursing 3RD Year
-O.I.N.S.R., DAMOH

3. INTRODUCTION
Shoulder dystocia has emerged as one of the
most important clinical and medico-legal
complications of vaginal delivery.

4. DEFINITION
 When fetal head is delivered but shoulders
are stuck and cannot be delivered, it is
known as shoulder dystocia.

6. CAUSES
 Large baby
 Failure of the shoulder or rotate into
anterio-posterior diameter after delivery of
head

7. MANAGEMENT
 Avoid 3ps
1. Pushing
2. Pulling
3. Pivoting

8. Management of shoulder dystocia types :-
1. Foreceps delivery :- Foreceps delivery means using
obstertic foreceps for delivery when the mother is unable
to deliver the baby by her own efforts.
Foreceps delivery is an assisted birth with the aid of forecep.
These are designed to crudle the baby head as traction on
handles assist baby to be turned.
Purpose :-
 To assist in delivery after coming head breech.
 To take out head up and out of pelvis at cesarean section
 To rotate and take out the head in an unfavourable positions
of baby in vertex presentation.
 To deliver baby quickly in case of fetal distress after fulfilling
the conditions for use forceps.

9. Indications for use of forceps :-
 Maternal
 Fetal
 Miscellaneous/Others
MATERNAL INDICATIONS
 Maternal heart disease
 Maternal exhaustion
 Inadequate expulsive effort
 Pre-eclampsia
FETAL INDICATIONS
 Fetal distress
 After coming head to breech
 Low birth weight baby
 Cord prolapse
 Post maturity

10. MISCELLANEOUS INDICATIONS
 Prolonged second stage of labour more than two hours and
more than one hour multipara
 To reduce the time for second of labour an in
 Severe eclampsia
 Heart disease of mothers
 Post cesarean pregnancy
TYPES OF FORCEPS USED
 High forceps
 Mid forceps
 Low forceps
 Outlet forceps
 Rotational /Non-rotational forceps

12. 2. Ventouse delivery :- It is an vaccum extractor or
ventouse is used to extract the fetus. Vaccum is an
instrumental device which is designed to assist the
delivery by creating a vaccum between each and the
fetal skull. The pulling force created by vaccum
dragging the cranium.
INDICATIONS
 Delay in descent of the head in case of second baby of
twins
 Uterine inertia causing delay in late first stage of
labour
 As an alternative of forceps used

13. CONTRAINDICATIONS
 Malpresentation such as face brow to breech
presentation
 Pre-term fetus
 Coagulation disorder
CRITERIA REQUIRED TO BE FULFILLED
 Head shoulder engaged
 Single baby
 Cervix should be at least 6cm dilated
COMPLICATIONS
 Maternal complications
 Fetal complications