Shoulder dystocia

Definition: Failure to deliver fetal shoulders with normal downward traction  Why we care: Baby hypoxia, brachial plexus injuries, maternal injuries Risk factors:  DM, excessive weight gain in pregnancy, S>D, Large baby Hx of shoulder dystocia (~10-15% recurrence) Turtling while pushing  Prevention  No real prevention as SD is very hard to predict  Offer cesarean delivery if EFW is >5000g and no DM, or >4500g and any type of DM What do to:  Step back. If comfortable, can help minimize family interference. Calmly explain what is happening and what the docs are doing.  Offer to be the Timekeeper. Write down times and what is happening. Announce every 2 minutes.  What you’ll see:  Prep: Hypothesize shoulder orientation for suprapubic pressure, place stool  Announce problem- call for help Maneuvers - McRobers, suprapubic Posterior arm Rotational: Wood’s screw, Rubin Gaskins- all 4s Episiotomy Zavanelli