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SHOULDER DYSTOCIA, FOR BABY, FOR MOTHER, (HELPERR mnemonic – easy to…
SHOULDER DYSTOCIA
DEFINITION
👉 An obstetric emergency where, after the baby’s head is born, the shoulders fail to deliver normally because the anterior shoulder is stuck behind the mother’s pubic bone.
RISK FACTORS
Maternal factors: diabetes, obesity, short stature, post-term pregnancy.
Labour factors: induction, prolonged second stage, instrumental delivery (forceps/vacuum).
Fetal factors: large baby (macrosomia), especially >4–4.5 kg, male babies.
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COMPLICATIONS
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Hypoxia → brain injury, death.
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MANAGEMENT
H – Call for Help 🚨 (obstetrician, anesthetist, paeds, extra staff).
E – Evaluate for Episiotomy (may help, but doesn’t relieve bony obstruction).
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E – Enter maneuvers (internal rotation, Rubin or Woods screw manoeuvre).
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WARNING SIGNS
“Turtle sign” 🐢 → kepala bayi keluar, tapi kemudian tertarik balik ke perineum kerana bahu tersangkut.
Prolonged head-to-body delivery time → kepala lahir, tapi badan lambat keluar.
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Difficulty with restitution & external rotation → kepala tak boleh berpusing macam biasa lepas keluar.
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⚠️ If all fails → Zavanelli manoeuvre (push head back, proceed to C-section) or clavicle fracture as last resort.