Shoulder dystocia

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