Shoulder Dystocia

Suspended

Step 1: View clinicals

A 32 year old woman at 42 weeks of gestation of her 2nd pregnancy presents in active labor. The baby is estimated to be 3.9 kg, with no anomalies. Despite regular, strong contractions, progression through the second stage of labor is slow. A ventouse is applied, following which the head of the baby delivers easily, but then immediately retracts, with the baby's chin abutting the perineum. Her 1st pregnancy was uncomplicated, with a 4.0 kg child delivered vaginally.


Step 2: Order all relevant investigations

Ultrasound Scan

You realize that an ultrasound scan will take time - time which you do not have.

View continuous CTG report

The baseline heart rate is 160 bpm, with reduced variability. Two accelerations are seen; there are no decelerations. Strong uterine contractions are noted.

Crossmatch & Reserve Blood

Her blood group is A positive; 2 pints of crossmatched blood are reserved.

Fetal Scalp Blood Sampling

You realize that the procedure will take time - time which you do not have.


Step 3: Select appropriate management

McRoberts position
Emergency LSCS
Suprabubic pressure
Symphysiotomy


Score: ★★☆