A.DESCRIPTION. In shoulder dystocia, the anterior shoulder of the baby is unable to pass under the maternal pubic arch.
B. ETIOLOGY. Shoulder dystocia is associated with advance maternal age, diabetes, maternal obesity, large baby (macrosomia), postdate pregnancy, and multiparity.
C. PATHOPHYSIOLOGY. The plane of the fetal shoulders aligns perpendicular to the pubis instead of an angle. This causes the shoulder to become wedged under the pubic arch.
D.ASSESSMENT FINDINGS
1. Associated findings. The birth process may seem unnecessarily prolonged.
2. Clinical manifestations.
a. The fetal head retracts against the mother’s perineum as soon as the head is delivered. This known as the “turtle sign.”
b. External rotation does not occur.
E.NURSING MANAGEMENT. Identify shoulder dystocia and assist with management.
1. Place the client in the McRobert’s position (thighs pulled up against the abdomen with hips abducted).
2. Apply suprapubic pressure.
