3. Shoulder Dystocia
• Shoulder dystocia occurs when after delivery
of the fetal head additional obstetrical
maneuvers are required to deliver the fetal
shoulders
10. Deliver the infant before the asphyxia
from umbilical cord compression,
without causing any fetal or maternal
trauma
11. Management principles
DONTs’:
• Do not be panick
• Do not give traction over baby’s head
• Do not apply fundal pressure
Dos’
• Call for extra help
• Clear the infant’s mouth and nose
• Involve the anesthetist and the pediatrician
• Perform episiotomy if not performed earlier
13. Case study
Mrs. Laxmi
• 26 years old
• G1@40 weeks of gestation
• Healthy-No medications
• Normal pregnancy
• Fully dilated –pushing
x2hrs
14.
15. 1. Pre-procedure steps and considerations:
– Shout for help
– Explain procedure
– Follow general principles of basic care
and infection prevention
– Perform episiotomy
Management
19. EXTERNAL PRESSURE
Apply pressure
suprapubicaly with palm
or fist, dierecting the
pressure on anterior
shoulder both downword
& laterally
Suprapubic pressure is
supposed to adduct the
shoulders or bring them
into an oblique plane
Since the oblique diameter
is the widest diameter of
the pelvis
20. • If the shoulder is still not
delivered: insert a hand
into the vagina and apply
pressure to the anterior
shoulder in the direction
of the baby’s sternum to
rotate the shoulder and
decrease the shoulder
diameter.
Rubin’s Maneuver
21. Rubin II
Inserting fingers of ONE
hand behind most
accessible fetal shoulder
Pushing shoulder toward
the fetus’chest
Collapse of shoulder girdle
23. Wood’s maneuver
If the shoulder is still not
delivered despite the
above measures:
• Progressively rotating
the posterior shoulder
180 degree in
corkscrew fashion
• The impacted anterior
shoulder could be
released
24. REMOVE THE POSTERIOR ARM
• Flex arm at elbow
• Apply pressure in
anticubital fossa to
flex arm
• Sweep arm over chest
• Grasp risk, forearm or
hand
• Deliver arm
25.
26. LAST RESORT OPTIONS
Fracture of the fetal clavicle
Zavenelli maneuver(returning the fetal head and
attempting the caesarian delivery)
Symphysiotomy
28. Documentation
Keeping Time is Imperative
Note time of delivery of head
Time kept for each maneuver of 30-60 seconds
Total time to delivery and mode of delivery
Who is in the room
when new providers are called/activated and enter the
room
Is FH still obtainable and what it is
Use all information for written documentation after delivery,
including discussion with patient about what occurred
30. 1. Pre-procedure steps and considerations:
– Shout for help
– Explain procedure
– Follow general principles of basic care
and infection prevention
– Perform episiotomy
Management
31.
32. EXTERNAL PRESSURE
Apply pressure
suprapubicaly with palm
or fist, dierecting the
pressure on anterior
shoulder both downword
& laterally
Suprapubic pressure is
supposed to adduct the
shoulders or bring them
into an oblique plane
Since the oblique diameter
is the widest diameter of
the pelvis