Dystocia: The Daily PANCE Blueprint

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Dystocia: The Daily PANCE Blueprint

A 38-year-old female (G2P1) at 33 weeks gestation with a history of diabetes comes to the clinic because of recently increased weight gain (over 35 lbs). Her vitals are unimpressive. Her BMI before pregnancy was 32. On exam, you palpate the uterus fundus at the costal arch. You order an ultrasound which estimates the fetal weight above the 90th percentile. The baby is at risk for which of the following?

A. Severe anemia
B. Neonatal hyperbilirubinemia
C. Shoulder dystocia
D. Chiari malformation
E. Hyaline membrane disease

Answer and topic summary

The answer is C. Shoulder dystocia

Shoulder dystocia is an obstetric emergency. It occurs when the shoulder of the fetus is stuck behind the pubic symphysis during delivery. Risk factors include maternal obesity, diabetes, the prolonged second stage of labor, fetal macrosomia, and a history of shoulder dystocia. You may notice the turtle sign, which is when the fetal head is partially delivered but retracts. Management includes having the mom lie supine with her buttock on the edge of the bed and perform the McRoberts maneuver. Other options include internal maneuvers, the Gaskin maneuver, fracture of the fetal clavicle, the Zavanelli maneuver, and symphysiotomy.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Reproductive System ⇒ Complicated Pregnancy ⇒ Dystocia

Also covered as part of the Women's Health EOR topic list

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