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