Procedure Ready: Ob/Gyn

Shoulder dystocia

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Shoulder dystocia is an unpredictable obstetric emergency where seconds matter. This episode covers the definition, risk factors, prevention counseling, exactly what you'll see in the delivery room, and how you as a student can be most useful – including timekeeping and supporting the family.

Show Outline:

  • Definition – Failure to deliver fetal shoulders with normal downward traction
  • Why We Care – Baby hypoxia, brachial plexus injuries, maternal injuries
  • Risk Factors – Diabetes, excessive weight gain, S>D, large baby, history of shoulder dystocia (~10–15% recurrence), turtling while pushing
  • Prevention – Difficult to predict. Offer cesarean if EFW >5000g (no DM) or >4500g (with DM).
  • Your Role – Step back. Help minimize family interference with calm explanations. Offer to be the timekeeper – write down times and events, announce every 2 minutes.
  • What You'll See
    • Hypothesize shoulder orientation, suprapubic pressure, place stool
    • Announce the problem and call for help
    • Maneuvers: McRoberts, suprapubic pressure, posterior arm delivery, rotational (Wood's screw, Rubin), Gaskin's (all fours), episiotomy, Zavanelli (last resort)

      • About the Speaker:

      Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators.

      Procedure Ready: Ob/Gyn is a podcast aimed at medical, PA, and NP students entering their clinical rotation in Ob/Gyn. The views expressed are the speaker's own and do not constitute medical advice.

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      Procedure Ready: Ob/GynBy Jennifer Doorey, MD, MS
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