SHOULDER DYSTOCIA


Risk factors--No good predictive system for shoulder dystocia; 50% of pts have no risk factors

Diagnosis:

Prevention:

Mnemonic for tx of Shoulder Dystocia

Help--Ask for it (extra pair of hands, peds, etc.)

Episiotomy--evaluate for it (usually won't be easy to do once shoulder is established, and only thing it achieves is more room for maneuvers

Legs (McRoberts' maneuver--flex hips without abduction, e.g. thighs on belly)

Pubic (suprapubic pressure; i.e. try to rotate shoulder with horizontal pressure suprapubically; do x 30-60sec)

Enter the vagina for maneuvers:

Roll pt to hands & knees position

Remove posterior arm = Follow posterior arm to elbow, flex elbow, sweep forearm across fetal chest; don't try to do by grasping fetal hand b/c this may lead to fx

(Sources include 2002 Advanced Life Support in Obstetrics course syllabus; American Academy of Family Physicians)