Hello and welcome to the Zero to Finals podcast.

My name is Tom and in this episode I'm going to be talking to you about shoulder

dystosia.

And you can find written notes on this topic at zero to finals.com slash shoulder dystosia

or in the labour and delivery section of the zero to finals obstetrics

and gynecology book so let's get straight into it shoulder dystosia occurs during delivery of the

baby when the anterior shoulder of the baby becomes stuck behind the pubic synthesis of the pelvis after the baby's head

has been delivered. This requires additional obstetric maneuvers to enable delivery of the

rest of the baby's body. Shoulder distosia is an obstetric emergency. It's often caused by macrosomia or a large baby secondary to gestational diabetes.

Let's talk about the presentation.

Shoulder dysthesia presents with difficulty delivering the face and head of the baby

and obstruction in delivering the shoulders after head of the baby and obstruction in delivering the shoulders

after delivery of the head. There may be failure of restitution where the head remains facing

downwards in an occipito anterior position and does not turn sideways as expected after delivery of the head.

The turtleneck sign is where the head is delivered but then it retracts back into the vagina.

Let's talk about management.

Shoulder dystetriac emergency and needs to be managed by experienced midwives and obstetricians.

The first step is to get help, including help from the anisotists and the pediatricians.

Several techniques can be used to manage the condition and deliver the baby.

An episiotomy can be used to enlarge the vaginal opening and reduce the risk of perineal tears, although an apiziotomy is not always necessary.

McRobberts' manoeuvre involves hyperflection of the mother at the hip, bringing her knees up to her abdomen.

This provides posterior pelvic tilt, lifting the pubic synthesis up and out of the way so that

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