What are the guideline sources, guidelines and references for Shoulder dystocia ?
Guideline sources The following summarized guidelines for the evaluation and management of shoulder dystocia (SD) are prepared by our editorial team based on guidelines from the American College of Obstetricians and Gynecologists (ACOG 2020; 2017) and the Royal College of Obstetricians and Gynaecologists (RCOG 2012). 1 2 3 Guidelines 1. Screening and diagnosis Diagnosis: consider performing routine traction in an axial direction to diagnose SD. Avoid performing any other traction. C 2. Classification and risk stratification https://web.pathway.md/diseases/recPGFdEUNXTjxTWl 1/3 6/24/23, 3:06 PM Shoulder dystocia Pathway Prediction of shoulder dystocia: As per RCOG 2012 guidelines: Be aware of existing risk factors in laboring females and be alert to the possibility of SD. B Recognize that risk assessments for the prediction of SD are insufficiently predictive to allow prevention of the large majority of cases. B 3. Medical management General principles: Manage SD systematically. B Call for additional help immediately after recognition of SD. State the problem clearly as 'this is SD' to the arriving team. B 4. Inpatient care Intrapartum monitoring: Ensure that all birth attendants are: aware of the methods for diagnosing SD and the techniques required to facilitate delivery looking for the signs of SD routinely alert to the possibility of postpartum hemorrhage and severe perineal tears. B 5. Therapeutic procedures McRoberts maneuver: as per RCOG 2012 guidelines, perform the McRoberts maneuver as the first intervention for SD. B Suprapubic pressure: apply suprapubic pressure to improve the effectiveness of the McRoberts maneuver. B Fundal pressure: do not apply fundal pressure. D Internal maneuvers: as per RCOG 2012 guidelines, perform internal maneuvers if the McRoberts maneuver and suprapubic pressure fail. B All fours position: perform 'all-fours' position if the McRoberts maneuver and suprapubic pressure fail. B Last-resort procedures: consider performing third-line maneuvers very carefully to avoid unnecessary maternal morbidity and mortality, particularly by inexperienced practitioners. C 6. Surgical interventions Episiotomy: do not perform episiotomy ruotinely. D https://web.pathway.md/diseases/recPGFdEUNXTjxTWl 2/3 6/24/23, 3:06 PM Shoulder dystocia Pathway 7. Patient education General counseling: provide an explanation of the delivery to the parents. B 8. Preventative measures Induction of labor: As per RCOG 2012 guidelines: Consider offering induction of labor at term to reduce the incidence of SD in patients with gestational diabetes. C Do not offer induction of labor for the prevention of SD in non-diabetic females with a suspected macrosomic fetus. D Cesarean delivery: as per RCOG 2012 guidelines, consider performing elective Cesarean delivery to reduce the potential morbidity for pregnancies complicated by preexisting or gestational diabetes, regardless of treatment, with an estimated fetal weight of > 4,500 g. C 9. Follow-up and surveillance Immediate care of the newborn: examine the newborn for injury by a neonatal clinician. B Birth after previous shoulder dystocia: decide on performing either Cesarean or vaginal delivery after previous SD, jointly by the patient and her carers. B 10. Quality improvement Health professional training: as per RCOG 2012 guidelines, ensure that all maternity staff participates in SD training at least annually. B Show 2 more Documentation: as per RCOG 2012 guidelines, ensure accurate and comprehensive documentation. B References 1. Royal College of Obstetricians and Gynaecologists. Shoulder Dystocia: Green top Guideline No. 42. RCOG. 1 Mar 2012. Open 2. No authors listed. Practice Bulletin No 178 Shoulder Dystocia. Obstet Gynecol. 2017 May;129 5):e123- e133. Open 3. No authors listed. Macrosomia: ACOG Practice Bulletin, Number 216. Obstet Gynecol. 2020 Jan;135 1):e18-e35. Open https://web.pathway.md/diseases/recPGFdEUNXTjxTWl 3/3