SHOULDER DYSTOCIA EXAM STUDY GUIDE
LATEST (2024/2025) COMPLETE VERIFIED AND
ACCURATE.
In what period of time can most cases of dystocia be resolved?
within 4 minutes
What sequential management can usually resolve dystocia within 4m?
(a) McRoberts and suprapubic pressure,
(b) rotational maneuvers, and
(c) delivery of the posterior arm
When should you attempt maneuvers?
ONLY BETWEEN contractions
Instruct the mom not to push
What maneuver is superior when it comes to shoulder dystocia?
- There is no evidence that any one maneuver is superior to another in releasing
an impacted shoulder or reducing the chance of injury.
- The initial choice and order of progression are at the provider's discretion.
What is a reasonable first maneuver?
- Mc Roberts maneuver (reasonable initial Maneuver)
- high success rate without increase in injury to the neonate
What are three P's of shoulder dystocia?
No pushing
No pulling
No pivoting
,Where should you NOT have your hands during a shoulder dystocia?
No pointing fingers toward the neck
What are the primary maneuvers?
- Mc Roberts Maneuver
- Suprapubic
- Position Change: Gaskin Maneuver (all-fours)
- Barnum Maneuver: Delivery of Posterior Arm
What are the rotational maneuvers?
- Shoulder Rotation (Rubin I & II)
- Wood's Screw Maneuver
What are the special care scenarios?
- Clavicular Fracture
- Cephalic Replacement (Zavanelli Maneuver)
- Symphysiotomy
- Abdominal rescue through hysterotomy
What is the goal of shoulder dystocia management?
atraumatic birth, not speed
What should you tell the women as soon as dystocia is diagnosed?
She should stop pushing
When should episiotomy happen with a shoulder dystocia?
Only if you need room to perform the maneuver. Otherwise episiotomy confers
no benefit averting neonatal injury.
What are the first three things you should do when you diagnose shoulder
dystocia?
, - Stay calm:
Simply waiting for the next contraction, even in births exhibiting a turtle sign,
lowers the incidence of shoulder dystocia
- Initiate dystocia clock:
Some providers find it useful for a nurse to verbally note the passage of time in
60 second intervals
- Call for help (attending, anesthesia, peds)
When obstetric help arrives, what should you do?
tell him or her what already has been done so as not to waste time.
What should you prepare for in the event of a shoulder dystocia?
- Prepare for full scale neonatal resuscitation
- Prepare for postpartum hemorrhage
How should you position the woman as soon as you diagnose dystocia?
- Position woman with her buttocks flush with the edge of the bed
What else should you consider when you diagnose dystocia?
- Drain bladder is distended
- Evaluate need for episiotomy
- R/O other causes of dystocia (such as impound presentation)
What should you do with a nuchal cord during dystocia?
should not be cut and clamped if at all possible.
What does McRobert's maneuver achieve regarding the mother's pelvis?
- straightens sacrum relative to lumbar spine (more room for the bisacromial
diameter)
- rotation of symphisis pubis cephalic and decrease in angle of inclination
- moves the sacral promontory (and potentially shrug the posterior shoulder
off)
LATEST (2024/2025) COMPLETE VERIFIED AND
ACCURATE.
In what period of time can most cases of dystocia be resolved?
within 4 minutes
What sequential management can usually resolve dystocia within 4m?
(a) McRoberts and suprapubic pressure,
(b) rotational maneuvers, and
(c) delivery of the posterior arm
When should you attempt maneuvers?
ONLY BETWEEN contractions
Instruct the mom not to push
What maneuver is superior when it comes to shoulder dystocia?
- There is no evidence that any one maneuver is superior to another in releasing
an impacted shoulder or reducing the chance of injury.
- The initial choice and order of progression are at the provider's discretion.
What is a reasonable first maneuver?
- Mc Roberts maneuver (reasonable initial Maneuver)
- high success rate without increase in injury to the neonate
What are three P's of shoulder dystocia?
No pushing
No pulling
No pivoting
,Where should you NOT have your hands during a shoulder dystocia?
No pointing fingers toward the neck
What are the primary maneuvers?
- Mc Roberts Maneuver
- Suprapubic
- Position Change: Gaskin Maneuver (all-fours)
- Barnum Maneuver: Delivery of Posterior Arm
What are the rotational maneuvers?
- Shoulder Rotation (Rubin I & II)
- Wood's Screw Maneuver
What are the special care scenarios?
- Clavicular Fracture
- Cephalic Replacement (Zavanelli Maneuver)
- Symphysiotomy
- Abdominal rescue through hysterotomy
What is the goal of shoulder dystocia management?
atraumatic birth, not speed
What should you tell the women as soon as dystocia is diagnosed?
She should stop pushing
When should episiotomy happen with a shoulder dystocia?
Only if you need room to perform the maneuver. Otherwise episiotomy confers
no benefit averting neonatal injury.
What are the first three things you should do when you diagnose shoulder
dystocia?
, - Stay calm:
Simply waiting for the next contraction, even in births exhibiting a turtle sign,
lowers the incidence of shoulder dystocia
- Initiate dystocia clock:
Some providers find it useful for a nurse to verbally note the passage of time in
60 second intervals
- Call for help (attending, anesthesia, peds)
When obstetric help arrives, what should you do?
tell him or her what already has been done so as not to waste time.
What should you prepare for in the event of a shoulder dystocia?
- Prepare for full scale neonatal resuscitation
- Prepare for postpartum hemorrhage
How should you position the woman as soon as you diagnose dystocia?
- Position woman with her buttocks flush with the edge of the bed
What else should you consider when you diagnose dystocia?
- Drain bladder is distended
- Evaluate need for episiotomy
- R/O other causes of dystocia (such as impound presentation)
What should you do with a nuchal cord during dystocia?
should not be cut and clamped if at all possible.
What does McRobert's maneuver achieve regarding the mother's pelvis?
- straightens sacrum relative to lumbar spine (more room for the bisacromial
diameter)
- rotation of symphisis pubis cephalic and decrease in angle of inclination
- moves the sacral promontory (and potentially shrug the posterior shoulder
off)
