Shoulder dystocia is defined as when the fetal head delivers but the shoulders do not deliver spontaneously or with normal traction. It has an incidence of 0.6-1% and is caused by an increase in fetal size relative to the head. Risk factors include maternal diabetes, obesity, macrosomia, and a previous history of shoulder dystocia. Management involves preliminary steps like calling for help and draining the bladder, followed by maneuvers like McRoberts, suprapubic pressure, or rotating the posterior shoulder anteriorly. Complications can include newborn death, asphyxia, brachial plexus injury, or maternal hemorrhage.

1. Shoulder Dystocia

2. Introduction
Shoulder Dystocia has eemerged as one of
most important clinical and medico legal
complication of vaginal delivery
 When shoulder Dystocia is anticipated
the mentally rehearse the sequence of
steps necessary to treat this problem
and be ready to perform logically, in a
step by step fashion

3. Definition
Shoulder Dystocia is defined when the fetal
head has delivered but the shoulder do not
delivered spontaneously or with normal
amount of gentle downward traction

4. Incidence
It is an obstetric emergency with an
incidence of approximately 0.6to1%

5. Causes
 Increase in fetal weight
 Increase in body size in
relation to head size

6. Risk factors
1) Antepartum
 Diabetic
 Maternal obesity
 Post partum pregnancy
 Past history of shoulder Dystocia

7. 2) Intrapartum
 Prolonged first stage
 Secondary arrest
 Prolonged second stage of labour

8. 3) predictive factors
 Maternal diabetes with estimated
fetal weight is >4.2 kg

9. Types of shoulder Dystocia

10. Diagnostic evaluation or prediction
* clinical examination
 Diagnosis of fetal macrosomia
 Estimated Fetal weight ultrasound

11. *Early Symptoms
Slow crowning

12. 2) Restitution is slow or does not occur
3) Turtle sign

13. * Late Symptoms
1) vascular congestion of face
2) vaginal examination is difficult
3)usual down traction of the head
does not result in appearance of
anterior shoulder

14. Management
Preliminary steps
* call for help
*Drain the bladder
*Perform Episiotomy
Avoid 5 P's
 Panic
 Pulling
 Pushing
 Pressure on the fundus
 Pivoting

15. Maneuvers used in shoulder
Dystocia
 MC Robert's Maneuver
 Suprapubic pressure
 Wood's Screw Maneuver
 Delivery of posterior shoulder
 Cliedotomy
 Zavanelli Maneuver

16. MC Robert's Maneuver
 Flexion of the Maternal thigs into
the abdomen
 Cephalic Rotation of the pelvics free
the anterior shoulder

17. MC Robert's Maneuver

18. 2) Suprapubic pressure
 Moderate suprapubic pressure is
often the only additional maneuver
necessary to disimpact anterior
fetal shoulder
 Stronger pressure can only be
exerted by an assistant

19. Suprapubic pressure

20. 3) wood screw maneuver
 General anaesthesia should
administered
 The posterior shoulder is rotated to
anterior position by a corkscrew
movement. This is done by inserting
two fingers into the posterior vagina ,
simultaneously suprapubic pressure is
applied

21. Wood screw maneuver

22. 4) Cliedotomy
 One or both clavicles may be cut
with the scissors to reduce the
shoulder Dystocia
 This is applicable to a living
anencephalic baby
 In dead fetus

23. Cliedotomy

24. 5) zavanelli Maneuver
 Pushing the fetus back to the
uterus and delivered by
caesarean section
 Replacement done within 4
min : good APGAR

25. Zavanelli Maneuver

26. Complication
 Death
 Asphyxia
 Mental Retardation
 Brachial plexus palsy
 Speech defects

27. * Maternal complication
 PPH
 Infection
 Laceration of vagina,
cervix