Shoulder Dystocia Scenario and Skill Stations
Scenario
You are a registrar on a night shift and the priority 1 phone goes off. 34yo G2P1 36/40 in labour and
the shoulders are stuck. They are 30 minutes away.
You are informed by the nurse coordinator that she has already spoken to the birthing suite and
their doctors have just scrubbed in to perform an emergency C-section. The Paediatric registrar is
also at this birth.
Skill Stations
This skill stations will be performed one after the other. There will be two doctors and two nurses
assigned to each station. Gareth Kameron is nearby and may be available to assist if he’s not busy on
the wards.
Station 1: Preparation of the Neonatal Resuscitare, with equipment, drug and demonstrate umbilical
vein cannulation.
Doctors: Faheem and Richie
Station 2: Demonstrate manoeuvres for shoulder dystocia using the baby dummy
Doctors: Kris and Larissa
Station 3: Demonstrate your competence with neonatal resuscitation
Doctors: Marie and Kevin
Station 1 How to Prepare for a Neonatal Resuscitation
At least one person capable of resuscitating a newborn and this is there only responsibility
Equipment
Suction equipment
Mechanical suction and tubing
Meconium aspirator
Bag and mask equipment
Bag mask with cushion rim face mask capable of providing positive pressure ventilation
Oxygen source (flow rate up to 10L/min) and tubing
Intubation equipment
Laryngoscope with straight blade, No. 0 (preterm) and No. 1 (term)
ETT 2.5, 3, 3.5, 4
Stylet
Scissors
Securing tape
C02 detector
LMA
*extra bulbs, batteries for laryngoscope
NGT tube
Medications
Epinephrine 1:10, 000 (0.1ml/kg)
Normal Saline
Umbilical vessel catheterization supplies
Sterile gloves
Scalpel or scissors
Antiseptic
Umbilical tape
Catheters 3.5F, 5F
Three-way stopcock
Syringes
Needles
How to Perform an Umbilical Vein Catheterization
1)
2)
3)
4)
Clean the cord with antiseptic
Place a tie around the base of the cord. Tightened.
Pre-fill the umbilical catheter size 5 with normal saline OR size 5 feeding tube
Using sterile technique cut the cord below the clamp that has been placed at birth about 12cm from the skin line
5) Insert the catheter pointing up towards the heart. Insert 4cm below the level of the skin
until you get free flow of blood on aspiration
6) Set aside the dilute blood (2ml), take off an additional 1ml for the blood test, give back the
2ml of bloods.
7) The line I now ready to use for fluid bolus or adrenaline
Station 2 Manoeuvres for Shoulder Dystocia
Station 3 Neonatal Resuscitation
Initial Assessment
At the time of birth, ask yourself 4 questions, if the answer is No to any of them continue the initial
steps of resuscitation
Term gestation?
Clear amniotic fluid?
Breathing or crying?
Good muscle tone?
Airway
To establish an airway
Provide warmth
Position the head and clear airway (suck nose then mouth)
Dry the skin and stimulate to breathe
Evaluation of Airway 30 seconds after the commencement of resuscitation
Evaluate respirations, heart rate and colour
If apneic or HR <100 proceed to assisted breathing
Breathing
Provide positive pressure ventilation for 30 seconds
Evaluation of the effect of breathing after 30 seconds
If the HR is less than 60bpm proceed to circulation (chest compressions 3:1)
Circulation
Support the circulation by providing chest compressions whilst continuing positive pressure
ventilation
Evaluation of the circulation after 30 seconds of chest compressions
If the HR is still below 60bpm proceed to giving drugs
Drugs
Administer epinephrine as you continue positive pressure ventilation and chest compressions
If HR remains less than 60bpm repeat chest compressions and adrenaline
*When HR above 60bpm chest compressions are stopped
*Positive pressure ventilation can be stopped when the HR is above 100 and the baby is breathing