Shoulder Dystocia

 anterior shoulder in vertex presentation impinges on the symphysis pubis.

Signs

• head appears to be pulled back tightly against the vulva

• infant is unable to breathe

  • chest compressed by vaginal canal

  • mouth kept shut by pressure on vulva

• oxygen deficit in 4-5 mins

Treatment (in order)

1. hyper-flex mother's thighs + suprapubic pressure (NOT fundal - worsens and may rupture uterus)

2. insert hand in posterior vagina to rotate infant

3. posterior shoulder pushed into hollow sacrum, posterior foetal arm flexed and delivered, arm used to rotate infant

4. head pushed back into vagina and Caesarean section performed

[ Home ] [ Up ]