Scenario in a Nutshell
Shoulder dystocia following forceps delivery requiring internal manoeuvres.
Stage 1: Shoulder dystocia just recognised. Help summoned and McRoberts’ position.
Stage 2: McRoberts’ and suprapubic pressure unsuccessful. Internal manoeuvres required for delivery.
Target Learner Groups
Midwives, obstetricians, anaesthetists and neonatal emergency team.
| Specific learning opportunities |
|---|
| Early recognition of shoulder dystocia and appropriate help sought |
| Knowledge of management of shoulder dystocia – demonstrate timely progression through the treatment algorithm |
| Demonstrate manoeuvres used |
| Demonstrate effective planning for after-coming emergencies associated with shoulder dystocia |
| Demonstrate effective communication between the team and to the incoming neonatal team |
| Demonstrate appropriate leadership and followership in different roles within the team |
| Suggested learners (to represent their normal roles) | In the room from the start | Available when requested |
|---|---|---|
| Midwife | √ | |
| Midwifery student | √ | |
| Midwife coordinator | √ | |
| Obstetric ST3+ | √ | |
| Obstetric ST6 | √ | |
| Anaesthetic ST3+ | √ | |
| Neonatal emergency team | √ | |
| Further midwives | √ | |
| Suggested facilitators | ||
| Faculty to play role of patient’s partner | √ |
Details for Facilitators
Patient Demographics
Name: Isma Age: 29 Gestation: 39+6 Booking weight: 78 kg Parity: P0 |
Scenario Summary for Facilitators
A 29-year-old primiparous woman, Isma, attended maternity triage in spontaneous labour at 39+6 weeks pregnant. She was known to have a baby measuring above the 90th centile and she was transferred to the consultant-led unit due to a suspicious CTG.
The labour progressed at an appropriate rate and she commenced active pushing as soon as she became fully dilated.
Thirty minutes in to the active second stage, a fetal bradycardia ensued.
The obstetric registrar on call delivered the fetal head with forceps and an episiotomy in the delivery room. The head delivers slowly and the fetal chin is tight to the perineum when the forceps are removed. The head does not restitute and the body is not deliverable with axial traction. The obstetric registrar instructs for the emergency buzzer to be pushed.
Delivery suite team respond to buzzer.
McRoberts’ manoeuvre and suprapubic rocking unsuccessful.
Internal manoeuvres required. Baby delivered with final internal manoeuvre attempted.
Set-up Overview for Facilitators
| Clinical setting | In a delivery room, on a delivery bed |
| Patient position | Lithotomy |
| Initial monitoring in place | None |
| Other equipment | 16G cannula dorsum left hand. Entonox mask/mouthpiece |
| Useful manikin functions | Birthing manikin or pelvic part-task trainer |
Medical Equipment
For core equipment checklist, see Chapter 9.
| Additional equipment specific to scenario | ||
|---|---|---|
| Episiotomy scissors | Entonox mask/mouthpiece | Local checklist for shoulder dystocia (if available) |
| Start of delivery notes – fetal bradycardia noted and subsequent timings of forceps delivery. Time of delivery of head | ||
Information Given to the Learners
| Information given to ST6 obstetrics, midwife and midwifery student who are in the room at the start of the scenario. |
|
| Information given to rest of learners |
|
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