SHOULDER DYSTOCIA

THERESIA WITAYOSI
FAA 111 0030

Incidens

Definition

Risk Factors

Term infants with shoulders wider than the

size of the head
Presence the DOPE (diabetes, obesity,
prolonged pregnancy, excessive fetal size or
maternal weight gain)
Long first stage
Prolonged labor
Long II stage
Toxin stimulation
Vaginal delivery with action

Diagnosis

pulled
The
baby's
is born
, but
the shoulder
keep
pressingrestrained
the vulva and
tightcan not be bo
Traction
on head
the head
is not
successfully

Prevention

When the high risk cesarean delivery with :

unusually large of fetus (> 5 kg), very large of fetus
( > 4,5 kg) with maternal diabetes, large of fetus
( > 4 kg) with a history of previous distocia, with II
lengthwise with a large fetus.
Identify and treat diabetes in mothers
Always be prepared when the time occurs
Recognize the existence of dystocia as early as
possible (attempt to push, press the fundus and
suprapubic and traction)
Note the time and immediately ask for help so
dystocia unknown.

Complication

Bone fracture (clavicula and humerus)

Brachial plexus injury
Hypoxia permanent brain damage
Bleeding birth canal laceration, episiotomy,
atonic uterus.

Management
ALARM :
A : ask for help
L : Lift the legs & buttocks
A : anterior shoulder
disimpaction
R : rotation of posterior
shoulder
Avoid 4 P :
1. Panic
M : manual removal posterior
2. Pulling
arm
3. Pusshing
4. Pivoting

A : Ask For Help

Call a helper to help

L : lift the legs & buttocks

( McRoberts Maneuver )

Mothers in the supine position

Flex the thighs so the knee becomes as close
as possible to the chest
Rotate the legs towards the outside

Do episiotomy with wide enough

Episiotomy + McRoberts Maneuver to
facilitate the posterior shoulder past the
promontory and into the pelvis

A : Anterior Shoulder Disimpaction

(Rubin manuver)

The baby's shoulders that wedged is pushed

away from the midline of mother, pressed on
top of the symphysis mother . The suprapubic
pressure is to encourage the posterior
shoulder of baby to be removed from the birth
canal and used the carpus

R: Rotation Of Posterior Shoulder

( Woods
Screw
Maneuver)
Use
two fingers
to press
the posterior
shoulder and rotate it 180 degrees so that
the posterior shoulder become the anterior
shoulder and the posterior shoulder into
position under the pubic arch , while the
anterior shoulder into the pelvic and turned
into a posterior, so that the anterior shoulder
so easy to be born

R: Rotation Of Posterior Shoulder

( Woods
Screw
Maneuver)
Use
two fingers
to press
the posterior
shoulder and rotate it 180 degrees so that
the posterior shoulder become the anterior
shoulder and the posterior shoulder into
position under the pubic arch , while the
anterior shoulder into the pelvic and turned
into a posterior, so that the anterior shoulder
so easy to be born

M: manual removal posterior arm

(Shwartz)

Usually the baby's arm is flexion at the elbow

When the arm is not flexed thrust arm at
the elbow
Push the arm towards the chest
Take the hand then reveal the hand

After the management

Alert the bleeding after childbirth

Inspection the presence of maternal
lacerations and trauma
check the baby
Informed consent

...Thank you...