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.
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
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
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
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
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