Shoulder Dystocia😊

Shoulder Dystocia

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  • Definition:
    • Delay in delivery of shoulder by 21 minutes after delivery of fetal head.
  • Sign:
    • Turtle sign (Head retracts against perineum).

Algorithm for management:

  • HELPERR mnemonic
    • H: Call for help.
    • E: Give liberal episiotomy.
    • L: Legs maneuver (McRoberts maneuver).
      • Flex the thighs and abduct them.
      • Leads to straightening of sacrum and increases available space.
    • P: Suprapubic pressure.
    • E: Enter the hand.
      • Rotate shoulders of baby (Woods corkscrew maneuver).
    • R: Remove/Deliver the posterior arm of baby.
    • R: Roll the patient on all 4 limbs (All fours maneuver/Gaskin maneuver).

Last step if everything fails is Zavanelli maneuver.

Notes:

  • During Normal Lithotomy → Stirrups → CPN injury → High stepping gait/foot drop
  • The most common nerve injured during McRoberts maneuver
    • Lateral cutaneous nerve of thigh.

Most Common Complications in Shoulder Dystocia:

  • Maternal: Postpartum Hemorrhage (PPH).
  • Fetal: Erb's palsy (Nerve roots: C5, C6).
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