Shoulder dystocia

Differential Diagnosis

Emergent delivery and related complications

• Emergent delivery
• Umbilical cord prolapse
• Breech delivery
• Shoulder dystocia
• Perimortem cesarean delivery

Treatment

• No method of delivery has been shown to be better or safer

HELPER

• H call for help
• E episiotomy (or episioproctotomy) to increase the anetroposterior diameter of passage
• L Legs flex (McRoberts maneuver)
• P Pressure- suprapubic pressure and Rubin’s maneuver (applying shoulder pressure to the fetus to decreases the bisacromial diameter)
• E Enter the vagina and attempt Wood’s corkscrew maneuver by pushing the most accessible shoulder toward the chest to corkscrew the shoulders through
• R Remove posterior arm by sweeping it across the chest and bring fetal hand to the chin, grasp and pull out of the birth canal and across the face

Complications

• Transient brachial plexus palsy (3.0 to 16.8 percent)
• Clavicular fracture (1.7 to 9.5 percent)
• Humerus fracture (0.1 to 4.2 percent)
• Permanent brachial plexus palsy (0.5 to 1.6 percent)
• Hypoxic-ischemic encephalopathy (0.3 percent)
• Death (0 to 0.35 percent)

See Also

• Emergent delivery