SHOULDER DYSTOCIA

LEARNING TASK
You are urgently called to the delivery room of a 26-year-old woman to help deliver the
baby. The mother is 41 weeks into her second pregnancy, having had a normal term
delivery of a 3.97 kg female infant 2 years ago. Nuchal and anomaly scans were normal
and antenatal care was unremarkable. The baby was moving normally prior to labour.
When she arrived on labour ward contracting, the symphysio-fundal height was noted to
be 41 cm. At first assessment the cervix was 3 cm dilated and she was advised to
continue mobilizing. Spontaneous rupture of membranes occurred and she was
examined again after 4h and the cervix was still 3 cm. A oxytocine infusion was
commenced to augment labour and an epidural sited, with cardiotocograph monitoring
also commenced. After 4h, the cervix was 7cm and then 10cm after a further 4h. The
woman was encouraged to start active pushing and 35 min later the head had crowned
in a direct occipito-anterior position.
The midwife noticed that the head did not extend normally on the perineum and that the
chin appeared to be wedged against the perineum. She had attempted delivery of the
shoulders with the next two contractions but this had not been achieved.
Questions
1. What is the diagnosis?
2. What are the risk factors in this case?
3. How would you manage this scenario?
4. What kind of complications that possibly happened in this case?

SELF ASSESSMENT
1. Discuss the diagnosis of shoulder dystocia
2. Discuss the incidence of shoulder dystocia
3. Discuss the risk factors of shoulder dystocia
4. Discuss the complications of shoulder dystocia
5. Discuss appropriate management of shoulder dystocia