Maternity Case: Amelia Sung
1. Uncontrolled maternal gestational diabetes
Rationale: Uncontrolled gestational diabetes leads to fetal macrosomia, fat pads at
the fetal neck, and increased maternal weight gain, all factors that increase the
incidence of shoulder dystocia. Preeclampsia and IUGR both result in smaller infants
and thus do not increase the risk of shoulder dystocia.
Hyperemesis, while it can continue throughout the pregnancy, is generally a
problem of the first trimester and not related to the delivery.: Which of the
following pregnancy-related conditions increase the risk for shoulder dystocia?
2. Provides an indicator of the potential for fetal compromise
Rationale: Documenting this sequence of events provides an indicator of thepotential
for fetal compromise related to decreased oxygenation. The time ofbirth is when the
entire body is born. The focus is on the well-being of the mother and fetus/baby, not
the team's response. The Apgar score is assignedusing the standard criteria.: The nurse
documents the following events: crowningat 0749, fetal head emerged at 0800, McRobert's
maneuver performed at 0802, suprapubic pressure applied at 0806, and fetal body
delivered at 0808. What is thesignificance of documenting these events?
3. To inform the provider about the fetal status
Rationale: A call-out is a clear and concise statement of data or an event that
everyone on the health care team needs to know to care for the patient effectively.
Changes in the FHR are not routinely announced in the delivery room, but in this
situation the call-out by the nurse is important to give data to the provider so the
provider can evaluate the fetal status and determine the next course of action. The
patient is focused on pushing out the fetus, so the information is not for her benefit.
The nurse's interpretation of routinefetal activity is documented in the patient's
chart, not verbally.: The nurse hasassessed that the patient in labor is at risk of shoulder
dystocia. After delivery of
the fetal head, the nurse states in a clear, loud voice, "Fetal heart rate 90 beats perminute
with minimal variability." Why is it important for the nurse to communicate this
information?
4. Flex the mother's thighs toward her abdomen
Rationale: Flexing the legs toward the abdomen allows the pelvis to open to its
maximum dimension. This position is used prior to application of suprapubic
pressure. Fundal pressure will not dislodge the fetal shoulders from under the bone.
Placing the mother's legs in stirrups enhances visualization but will not
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, Maternity Case: Amelia Sung
facilitate delivery of the fetus.: What is the first action by the nurse to assist withthe
delivery of the fetal shoulders and body when there is shoulder dystocia?
5. Asphyxia, Erb's palsy, Fractured clavicle
Rationale: Erb's palsy occurs due to stretching of the brachial plexus. The clavicle or
humerus may be fractured during the manipulation to free the shoulders. Asphyxia
is a risk because the head is delivered in advance of the body and there is pressure
on the cord and placenta, which alters fetal oxygenation. Shoulder dystocia does not
cause injuries to the lower body orlower extremities, such as fractured femur or
talipes equinovarus.: Which of the following are common fetal or neonatal injuries seen
after shoulder dystocia? (Select all that apply)
6. The fetal head emerges and then retracts tightly against the perineal floor.
Rationale: A positive turtle sign is when the head delivers and then is retractedback and
rests firmly against the perineum.: What is a positive turtle sign?
7. Explain to the patient and family what may happen, Put a step stool at the
bedside, Have extra staff available if needed
Rationale: The stool is used so the provider applying suprapubic pressure can stand
directly over the patient. Extra staff is needed to implement the maneuvers used to
deliver the fetal shoulders. Communicating to the patientand family about what
might happen in the delivery room will help to preparethem and to decrease their
anxiety. Removing the family from the delivery room is not a therapeutic response
and will further increase their anxiety.
A consent for a cesarean delivery is not appropriate at this time.: When a shoulder
dystocia emergency is anticipated, what additional actions should be implemented by
the nurse? (Select all that apply)
8. Estimated fetal weight 8 lb, 13 oz (4,000 g) or more, Maternal height 5 ft, 3 in(160
cm), Maternal weight gain greater than 50 lb (23 kg)
Rationale: Excessive maternal weight gain, short stature of the mother, and high
estimated fetal weight are risk factors for shoulder dystocia. Ethnicity isa
demographic factor not associated with this condition. Previous delivery isevidence
that she is able to deliver an infant of that size, and an active phase oflabor lasting 4
hours is not a significant finding.: A patient is admitted to the laborand delivery unit at 40
weeks gestation. Which of the following pieces of informationcollected during the patient
interview would be most significant in alerting the nurseto the potential for shoulder
dystocia? (Select all that apply)
2/6
1. Uncontrolled maternal gestational diabetes
Rationale: Uncontrolled gestational diabetes leads to fetal macrosomia, fat pads at
the fetal neck, and increased maternal weight gain, all factors that increase the
incidence of shoulder dystocia. Preeclampsia and IUGR both result in smaller infants
and thus do not increase the risk of shoulder dystocia.
Hyperemesis, while it can continue throughout the pregnancy, is generally a
problem of the first trimester and not related to the delivery.: Which of the
following pregnancy-related conditions increase the risk for shoulder dystocia?
2. Provides an indicator of the potential for fetal compromise
Rationale: Documenting this sequence of events provides an indicator of thepotential
for fetal compromise related to decreased oxygenation. The time ofbirth is when the
entire body is born. The focus is on the well-being of the mother and fetus/baby, not
the team's response. The Apgar score is assignedusing the standard criteria.: The nurse
documents the following events: crowningat 0749, fetal head emerged at 0800, McRobert's
maneuver performed at 0802, suprapubic pressure applied at 0806, and fetal body
delivered at 0808. What is thesignificance of documenting these events?
3. To inform the provider about the fetal status
Rationale: A call-out is a clear and concise statement of data or an event that
everyone on the health care team needs to know to care for the patient effectively.
Changes in the FHR are not routinely announced in the delivery room, but in this
situation the call-out by the nurse is important to give data to the provider so the
provider can evaluate the fetal status and determine the next course of action. The
patient is focused on pushing out the fetus, so the information is not for her benefit.
The nurse's interpretation of routinefetal activity is documented in the patient's
chart, not verbally.: The nurse hasassessed that the patient in labor is at risk of shoulder
dystocia. After delivery of
the fetal head, the nurse states in a clear, loud voice, "Fetal heart rate 90 beats perminute
with minimal variability." Why is it important for the nurse to communicate this
information?
4. Flex the mother's thighs toward her abdomen
Rationale: Flexing the legs toward the abdomen allows the pelvis to open to its
maximum dimension. This position is used prior to application of suprapubic
pressure. Fundal pressure will not dislodge the fetal shoulders from under the bone.
Placing the mother's legs in stirrups enhances visualization but will not
1/6
, Maternity Case: Amelia Sung
facilitate delivery of the fetus.: What is the first action by the nurse to assist withthe
delivery of the fetal shoulders and body when there is shoulder dystocia?
5. Asphyxia, Erb's palsy, Fractured clavicle
Rationale: Erb's palsy occurs due to stretching of the brachial plexus. The clavicle or
humerus may be fractured during the manipulation to free the shoulders. Asphyxia
is a risk because the head is delivered in advance of the body and there is pressure
on the cord and placenta, which alters fetal oxygenation. Shoulder dystocia does not
cause injuries to the lower body orlower extremities, such as fractured femur or
talipes equinovarus.: Which of the following are common fetal or neonatal injuries seen
after shoulder dystocia? (Select all that apply)
6. The fetal head emerges and then retracts tightly against the perineal floor.
Rationale: A positive turtle sign is when the head delivers and then is retractedback and
rests firmly against the perineum.: What is a positive turtle sign?
7. Explain to the patient and family what may happen, Put a step stool at the
bedside, Have extra staff available if needed
Rationale: The stool is used so the provider applying suprapubic pressure can stand
directly over the patient. Extra staff is needed to implement the maneuvers used to
deliver the fetal shoulders. Communicating to the patientand family about what
might happen in the delivery room will help to preparethem and to decrease their
anxiety. Removing the family from the delivery room is not a therapeutic response
and will further increase their anxiety.
A consent for a cesarean delivery is not appropriate at this time.: When a shoulder
dystocia emergency is anticipated, what additional actions should be implemented by
the nurse? (Select all that apply)
8. Estimated fetal weight 8 lb, 13 oz (4,000 g) or more, Maternal height 5 ft, 3 in(160
cm), Maternal weight gain greater than 50 lb (23 kg)
Rationale: Excessive maternal weight gain, short stature of the mother, and high
estimated fetal weight are risk factors for shoulder dystocia. Ethnicity isa
demographic factor not associated with this condition. Previous delivery isevidence
that she is able to deliver an infant of that size, and an active phase oflabor lasting 4
hours is not a significant finding.: A patient is admitted to the laborand delivery unit at 40
weeks gestation. Which of the following pieces of informationcollected during the patient
interview would be most significant in alerting the nurseto the potential for shoulder
dystocia? (Select all that apply)
2/6
