Definition: Failure to deliver fetal shoulders with normal downward traction&nbsp;
Why we care: Baby hypoxia, brachial plexus injuries, maternal injuries
Risk factors:&nbsp;
<ul>
<li>DM, excessive weight gain in pregnancy, S&gt;D, Large baby</li>
<li>Hx of shoulder dystocia (~10-15% recurrence)</li>
<li>Turtling while pushing&nbsp;</li>
</ul>
Prevention&nbsp;
<ul>
<li>No real prevention as SD is very hard to predict&nbsp;</li>
<li>Offer cesarean delivery if EFW is &gt;5000g and no DM, or &gt;4500g and any type of DM</li>
</ul>
What do to:&nbsp;
<ul>
<li style="font-weight: 400;" aria-level="1">Step back. If comfortable, can help minimize family interference. Calmly explain what is happening and what the docs are doing.&nbsp;</li>
<li style="font-weight: 400;" aria-level="1">Offer to be the Timekeeper. Write down times and what is happening. Announce every 2 minutes.&nbsp;</li>
</ul>
What you&rsquo;ll see:&nbsp;
<ul>
<li>Prep: Hypothesize shoulder orientation for suprapubic pressure, place stool&nbsp;</li>
<li>Announce problem- call for help</li>
<li>Maneuvers - McRobers, suprapubic
<ul>
<li>Posterior arm</li>
<li>Rotational: Wood&rsquo;s screw, Rubin</li>
<li>Gaskins- all 4s</li>
<li>Episiotomy</li>
<li>Zavanelli&nbsp;</li>
</ul>
</li>
</ul>

<description>&lt;p&gt;&lt;span style="font-weight: 400;"&gt;Definition: Failure to deliver fetal shoulders with normal downward traction&amp;nbsp;&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style="font-weight: 400;"&gt;Why we care: Baby hypoxia, brachial plexus injuries, maternal injuries&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style="font-weight: 400;"&gt;Risk factors:&amp;nbsp;&lt;/span&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span style="font-weight: 400;"&gt;DM, excessive weight gain in pregnancy, S&amp;gt;D, Large baby&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;Hx of shoulder dystocia (~10-15% recurrence)&lt;/li&gt;
&lt;li&gt;Turtling while pushing&amp;nbsp;&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&lt;span style="font-weight: 400;"&gt;Prevention&amp;nbsp;&lt;/span&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span style="font-weight: 400;"&gt;No real prevention as SD is very hard to predict&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;Offer cesarean delivery if EFW is &amp;gt;5000g and no DM, or &amp;gt;4500g and any type of DM&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&lt;span style="font-weight: 400;"&gt;What do to:&amp;nbsp;&lt;/span&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li style="font-weight: 400;" aria-level="1"&gt;&lt;span style="font-weight: 400;"&gt;Step back. If comfortable, can help minimize family interference. Calmly explain what is happening and what the docs are doing.&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li style="font-weight: 400;" aria-level="1"&gt;&lt;span style="font-weight: 400;"&gt;Offer to be the Timekeeper. Write down times and what is happening. Announce every 2 minutes.&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&lt;span style="font-weight: 400;"&gt;What you&amp;rsquo;ll see:&amp;nbsp;&lt;/span&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span style="font-weight: 400;"&gt;Prep: Hypothesize shoulder orientation for suprapubic pressure, place stool&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;Announce problem- call for help&lt;/li&gt;
&lt;li&gt;Maneuvers - McRobers, suprapubic
&lt;ul&gt;
&lt;li&gt;Posterior arm&lt;/li&gt;
&lt;li&gt;Rotational: Wood&amp;rsquo;s screw, Rubin&lt;/li&gt;
&lt;li&gt;Gaskins- all 4s&lt;/li&gt;
&lt;li&gt;Episiotomy&lt;/li&gt;
&lt;li&gt;Zavanelli&amp;nbsp;&lt;/li&gt;
&lt;/ul&gt;
&lt;/li&gt;
&lt;/ul&gt;</description>

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 




Procedure Ready: Ob/Gyn

Shoulder dystocia

Shoulder dystocia

Description