GROUP 2 – SHOULDER DYSTOCIA

You are working as a Labor and Delivery Nurse at a local hospital. Patient A.M., a 26-year-old
G3 P2 (2002) at 41 weeks of gestation came in having contractions and feeling uncomfortable.
Upon internal examination, the cervix was found to be 3 cm dilated. Fundic height was noted to
be 40 cm. She was then admitted for monitoring of labor and delivery. She was initially advised
to continue mobilizing,
Obstetrical history was taken and documented. Her first baby was delivered 4 years ago via
normal spontaneous delivery with birthweight of 3,700 grams. The second baby was delivered 2
years ago, via forceps delivery with birthweight of 3,900 grams. In this pregnancy, she was
diagnosed to have gestational diabetes mellitus at 28 weeks age of gestation. Pelvic ultrasounds
were normal and antennal care being unremarkable. The baby was moving actively normal prior
to labor.
Four hours later, spontaneous rupture of membranes occurred. She was examined again and the
cervix was still at 3 cm. An oxytocin infusion was started to augment labor with cardiotocograph
monitoring. After 4 hours, the cervix was 7 cm. After 4 hours again, internal ‘examination
revealed 10 cm. She was then transferred to the delivery room,
‘She was encouraged to start active pushing and 30 minutes later, the head had crowned in A
occipito-anterior position. The midwife noticed that the head did not extend normally on the
perineum and that the chin appeared to be fixed in the perineum, she had attempted delivery of
the shoulders with the next three contractions but this had not been achieved.