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Labor Stage 2: Normal and Abnormal Labor

by Veronica Gillispie, MD, FACOG
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    Now as part of abnormal labor, let's discuss Shoulder Dystocia. So here's a clinical pearl. Shoulder dystocias are unpredictable so you should always be prepared. There are some signs that you can look for such as prolonged second stage of labor. But any delivery has the potential to become a shoulder dystocia. Any delivery requiring more than one routine maneuver to accomplish the delivery is considered a dystocia. In a shoulder dystocia the anterior shoulder of the infant gets impacted behind the maternal pubic symphysis. While shoulder dystocias can happen in any delivery there are some risk factors. First, fetal macrosomia. Next, maternal obesity. Next a long second stage of labor in moms that are diabetic or have gestational diabetes. There's an increased risk of shoulder dystocia. And if a mom have a history of shoulder dystocia in a previous pregnancy, she's increased risk during that pregnancy. So this is an ominous sign. It's called the Turtle Sign. And you can see here the chin is retracted against the maternal perineum and that's because the anterior shoulder is stuck behind the pubic symphysis. This causes the head to recoil after delivery. So what do we do when we see a shoulder dystocia. Where's here is a mnemonic to help you. It's called HELPERR. First you want to call for help. So when you are doing that delivery and you see that the anterior shoulder is not delivering, or you see the turtle sign that we discussed, you have a shoulder dystocia and you should call for Help. Help means calling other nurses in the room. Calling for an additional obstetrician and possibly contacting your anesthesiologist. The next thing to do is consider an Episiotomy. Now I say consider an episiotomy because we have to remember that a shoulder dystocia is...

    About the Lecture

    The lecture Labor Stage 2: Normal and Abnormal Labor by Veronica Gillispie, MD, FACOG is from the course Intrapartum Care. It contains the following chapters:

    • Second Stage of Labor
    • Stage 2 – Normal Labor
    • Stage 2 – Abnormal

    Included Quiz Questions

    1. Arrest of labor due to fetal malpresentation or fetal-pelvic disproportion; cesarean section should be the next step.
    2. Arrest of labor due to fetal malpresentation or fetal-pelvic disproportion; operative vaginal delivery should be the next step.
    3. Protracted second stage of labor due to fetal malpresentation; allow for another 1 hour of passive decent and rest to avoid maternal exhaustion.
    4. Protracted second stage of labor due to pelvic disproportion; operative vaginal delivery should be the next step.
    5. Normal progression of second stage of labor; continue expectant management and coaching pushing with mom.
    1. 2 hours
    2. 1 hour
    3. 3 hours
    4. 4 hours
    5. 6 hours
    1. 2 hours
    2. 3 hours
    3. 1 hour
    4. 4 hours
    5. 6 hours
    1. Extension of the head
    2. Flexion of the chin
    3. External rotation
    4. Internal rotation
    5. Expulsion

    Author of lecture Labor Stage 2: Normal and Abnormal Labor

     Veronica Gillispie, MD, FACOG

    Veronica Gillispie, MD, FACOG


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