Management of the client with a Shoulder Dystocia

Intent Statement:

Shoulder Dystocia is the impaction of the fetal shoulders against the pubis (check definition from NICE GUIDELINES). It is a delivery that requires additional maneuvers to deliver the shoulders. If not dealt with expeditiously fetal death can occur. The obstetrician must be informed as soon as the problem is recognized.

PROCEDURE 

The Midwife shall:- 

5.1.1 Recognize the problem and call for assistance. 

5.1.2 Call Registrar/Consultant, theatre anesthetist, and pediatrician. 

 5.1.3 Note the time of delivery of the head. 

5.1.4 Explain the procedure to the client to gain her cooperation. 

5.1.5 Avoid fundal pressure and extensive traction on the fetal neck. 

5.1.6 Perform an episiotomy if possible. 

5.1.7 Conduct the Mc Roberts maneuver. 

5.1.8 Apply suprapubic pressure over the fetal anterior shoulder. 

5.1.9 Attempt to deliver the posterior shoulder. 

5.1.10 Ensure the pediatrician is present for the delivery as well as ensuring that resuscitative

equipment is present and functional. 

5.1.11 Follow established infection prevention and control guidelines according to IPC manual. 

Following delivery 

Note time of delivery of a baby 

💥 Time of call for assistance 

💥Baby’s condition 

💥Names of staff present 

💥Complete incident form 

💥 Affix signature 

The Obstetrician shall-: 

 5.1.12 Explain the procedure to the client including the inherent risks and obtain informed consent

5.1.13 Attempt different maneuvers to deliver the baby as in 5.1.7.-5.1.9 and if all else fails

then Zavannelli maneuver should be considered. 

5.1.14 Alert Operating theatre staff and anesthetist, client/patient to be transferred to the OT if all attempts fail. 

5.1.15 Complete the Shoulder Dystocia form. 

 5.1.16 Follow established infection prevention and control guidelines according to IPC manual.