SHOULDER DYSTOCIA
SHOULDER DYSTOCIA
Presented by Dr . E . G. Migwi
• -an uncommon obstetric complication of cephalic vaginal deliveries
• -the fetal shoulders do not deliver after the head has emerged from the mother’s introitus.
• -One or both shoulders become impacted against the bones of the maternal pelvis (mechanical reasons).size or positional discrepancy, thus almost always after 34 weeks.
Anterior shoulder impacted behind the symphysis pubis and also posterior shoulder impacted behind the sacral promontory
Risk factors
Impossible to predict/ can occur without risk factors.
1. Ante partum
• -History of shoulder dystocia in a prior vaginal delivery
• -Fetal macrosomia (having a disproportionately large body compared to head)
• -Diabetes/impaired glucose tolerance
• -Excessive weight gain (15.8757 kg) during pregnancy
• -Obesity (body mass index >30 kg/m 2)
• -Asymmetric accelerated fetal growth in non-diabetic patients
• -Post term pregnancy
2. Intrapartum
• -Precipitous second stage (< 20 min)
• -Prolonged second stage
Without regional anesthesia (>2 h for nulliparous patients, or >1 h for multiparous patients)
With regional anesthesia (>3 h for nulliparous patient, >2 h for others
• -Induction of labor for "impending macrosomia".
Technique / management
• Cord pH drops with increasing head-to-body delivery interval, but the drop does not become clinically significant for about 5 minutes • Each maneuver should take 30 seconds ,
Fetal Maneuvers
Maternal Maneuvers
Rubin maneuver
McRoberts maneuver
Jacquemier maneuver
(posterior arm delivery)
Suprapubic pressure
Woods screw maneuver
Gaskin maneuver (all-fours)
Zavanelli maneuver (cephalic replacement) Sims maneuver (lateral decubitus) Cleidotomy
Ramp maneuver
Shute forceps maneuver
Symphysiotomy
MANEUVERS :
• Episiotomy not listed -The only reason to perform an episiotomy in the setting of shoulder dystocia is to eliminate soft tissue resistance that is interfering with the ability to insert the whole
Presented by Dr . E . G. Migwi
• -an uncommon obstetric complication of cephalic vaginal deliveries
• -the fetal shoulders do not deliver after the head has emerged from the mother’s introitus.
• -One or both shoulders become impacted against the bones of the maternal pelvis (mechanical reasons).size or positional discrepancy, thus almost always after 34 weeks.
Anterior shoulder impacted behind the symphysis pubis and also posterior shoulder impacted behind the sacral promontory
Risk factors
Impossible to predict/ can occur without risk factors.
1. Ante partum
• -History of shoulder dystocia in a prior vaginal delivery
• -Fetal macrosomia (having a disproportionately large body compared to head)
• -Diabetes/impaired glucose tolerance
• -Excessive weight gain (15.8757 kg) during pregnancy
• -Obesity (body mass index >30 kg/m 2)
• -Asymmetric accelerated fetal growth in non-diabetic patients
• -Post term pregnancy
2. Intrapartum
• -Precipitous second stage (< 20 min)
• -Prolonged second stage
Without regional anesthesia (>2 h for nulliparous patients, or >1 h for multiparous patients)
With regional anesthesia (>3 h for nulliparous patient, >2 h for others
• -Induction of labor for "impending macrosomia".
Technique / management
• Cord pH drops with increasing head-to-body delivery interval, but the drop does not become clinically significant for about 5 minutes • Each maneuver should take 30 seconds ,
Fetal Maneuvers
Maternal Maneuvers
Rubin maneuver
McRoberts maneuver
Jacquemier maneuver
(posterior arm delivery)
Suprapubic pressure
Woods screw maneuver
Gaskin maneuver (all-fours)
Zavanelli maneuver (cephalic replacement) Sims maneuver (lateral decubitus) Cleidotomy
Ramp maneuver
Shute forceps maneuver
Symphysiotomy
MANEUVERS :
• Episiotomy not listed -The only reason to perform an episiotomy in the setting of shoulder dystocia is to eliminate soft tissue resistance that is interfering with the ability to insert the whole