Shoulder dystocia after mid-cavity vacuum — emergency drill station

Timed drill-style emergency management station: shoulder dystocia following mid-cavity instrumental birth in a diabetic pregnancy — the highest-failure subgroup. Tests declaration and timekeeping, the manoeuvre ladder with technique, escalation discipline, prohibition of fundal pressure, parental communication and the medico-legal record. Includes a minute-by-minute assessor timeline, marking domains, assessor key and fail criteria.

Prompt

A 36-year-old G3P1 with insulin-requiring gestational diabetes is at 39+5 weeks. After a mid-cavity vacuum for a prolonged second stage and a pathological trace, the head delivers at 22:41 and immediately retracts onto the perineum. There is no restitution. You are the registrar in the birth room with a senior midwife, a student midwife and an anaesthetist. The consultant is at home, 20 minutes away.

Station brief

Format. Drill-style emergency management station, 12 minutes, run against a clock the assessor calls out loud. You are the obstetric registrar in the birth room. A senior midwife, a student midwife and an anaesthetist are present; the consultant has been phoned and is 20 minutes away. The assessor plays the team and feeds you new information at fixed times. ^[1]^[8]

Candidate instruction. Lead the management of a shoulder dystocia. Verbalise every action, name each manoeuvre before you perform it, direct your team by name and role, and state the time whenever you act. You will be asked at the end for your documentation and your conversation with the parents. ^[1]

References8Show

[1]American College of Obstetricians and Gynecologists Practice Bulletin No 178: Shoulder Dystocia Obstet Gynecol, 2017.PMID 28426618
[2]Hoffman MK, Bailit JL, Branch DW, et al. A comparison of obstetric maneuvers for the acute management of shoulder dystocia Obstet Gynecol, 2011.PMID 21555962
[3]Lok ZL, Cheng YK, Leung TY, et al. Predictive factors for the success of McRoberts' manoeuvre and suprapubic pressure in relieving shoulder dystocia: a cross-sectional study BMC Pregnancy Childbirth, 2016.PMID 27793109
[4]Leung TY, Stuart O, Sahota DS, et al. Head-to-body delivery interval and risk of fetal acidosis and hypoxic ischaemic encephalopathy in shoulder dystocia: a retrospective review BJOG, 2011.PMID 21199293
[5]Bruner JP, Drummond SB, Meenan AL, et al. All-fours maneuver for reducing shoulder dystocia during labor J Reprod Med, 1998.PMID 9610468
[6]Cluver CA, Hofmeyr GJ Posterior axilla sling traction: a technique for intractable shoulder dystocia Obstet Gynecol, 2009.PMID 19155929
[7]Matsuo K, Shiki Y, Yamasaki M, et al. Use of uterine fundal pressure maneuver at vaginal delivery and risk of severe perineal laceration Arch Gynecol Obstet, 2009.PMID 19263062
[8]Crofts JF, Lenguerrand E, Bentham GL, et al. Prevention of brachial plexus injury-12 years of shoulder dystocia training: an interrupted time-series study BJOG, 2016.PMID 25688719

Shoulder dystocia after mid-cavity vacuum — emergency drill station

Station brief

References8Show

[1]American College of Obstetricians and Gynecologists Practice Bulletin No 178: Shoulder Dystocia Obstet Gynecol, 2017.PMID 28426618
[2]Hoffman MK, Bailit JL, Branch DW, et al. A comparison of obstetric maneuvers for the acute management of shoulder dystocia Obstet Gynecol, 2011.PMID 21555962
[3]Lok ZL, Cheng YK, Leung TY, et al. Predictive factors for the success of McRoberts' manoeuvre and suprapubic pressure in relieving shoulder dystocia: a cross-sectional study BMC Pregnancy Childbirth, 2016.PMID 27793109
[4]Leung TY, Stuart O, Sahota DS, et al. Head-to-body delivery interval and risk of fetal acidosis and hypoxic ischaemic encephalopathy in shoulder dystocia: a retrospective review BJOG, 2011.PMID 21199293
[5]Bruner JP, Drummond SB, Meenan AL, et al. All-fours maneuver for reducing shoulder dystocia during labor J Reprod Med, 1998.PMID 9610468
[6]Cluver CA, Hofmeyr GJ Posterior axilla sling traction: a technique for intractable shoulder dystocia Obstet Gynecol, 2009.PMID 19155929
[7]Matsuo K, Shiki Y, Yamasaki M, et al. Use of uterine fundal pressure maneuver at vaginal delivery and risk of severe perineal laceration Arch Gynecol Obstet, 2009.PMID 19263062
[8]Crofts JF, Lenguerrand E, Bentham GL, et al. Prevention of brachial plexus injury-12 years of shoulder dystocia training: an interrupted time-series study BJOG, 2016.PMID 25688719