Shoulder dystocia

What does the PH of cord gasses drop by per minute of hypoxia?

drops by 0.04 per minute of hypoxia

what is the purpose of cord gasses in shoulder dystocia?

This helps to determine if this was an acute event of hypoxia or a chronic event of hypoxia as this will help to develop a plan of carer moving forward.

What are the risk factors for shoulder dystocia?

• IOL and oxytocin augmentation

• short stature

• GDM

• Bicornate uterus/uterine abnormalities

• postdates

• Failed ECV

• Instrumental delivery

• fetal macrasomia/LGA- EFW >4.5kg

• polgyhydramnoius and oligohydramnious

• ethnic majorities

• presentation of fetus

• prolonged 1st and 2nd stage

• raised BMI

• Maternal age

• nuliparity

• pelvic shape

• congenital abnormalities

what percentage of shoulder dystocia occur with no risk factors?

48% of shoulder dystocia cases occur with no risk factors present and a normal fetal weight.

What are the maternal risk factors associated with shoulder dystocia?

• increased risk of PPH

• increased risk of 3rd and 4th degree tears

• increased risk of psychological trauma

What are the neonatal risks of shoulder dystocia?

• brachial plexus injury

• clavicle fractures

• humeral fractures

• asphyxia

• fetal death

What can impact on the ability to do McRobert’s?

Increased progesterone and relaxin levels in pregnancy relaxes the ligaments of the pelvis, in some women this causes the pelvic bones to move asymmetrically, particularly when walking or putting their legs into different positions, this means that they will experience significant pain during this movement. Moving their legs into McRobert’s can be very painful for these women and they may find it difficult to move their positions, i.e. trying all fours. Extra care and support should be given to these woman and if McRobert’s has to be used during labour due to shoulder dystocia, considerations could be made to refer the woman to physio to prevent any long-term impacts she may experience from this.

What is the definition of shoulder dystocia?

A vaginal cephalic delivery that requires additional obstetric manoeuvres to deliver the baby after the head has delivered and gentle traction has failed.