Procedure Ready: Ob/Gyn

Shoulder dystocia

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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 
            • ...more
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            Procedure Ready: Ob/GynBy Jennifer Doorey, MD, MS
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