Shoulder Dystocia Documentation

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Shoulder DystociaDocumentation

• Phillip N. Rauk, MD

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Shoulder Dystocia Facts And Strategies

• Most often unpredictable 0.2 3.0 of
  deliveries
• Most brachial plexus injuries will resolve within
  a year but you cant be sure in advance which
  ones will.
• Standard of care is to perform correctly when it
  is encountered.
• When there are risk factors, it is probably
  prudent to inform the parents and discuss
  options. It is also reasonable and acceptable to
  make a recommendation based on your knowledge and
  experience.
• Get credit for meeting the standard with
  appropriate documentation
• Shift to the management of bad results mode of
  care when injury occurs.

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What Does ACOG Say?

• November, 2002. The following recommendations
  are based on limited or inconsistent scientific
  evidence
• Shoulder Dystocia cannot be predicted or
  prevented because accurate methods for
  identifying which fetuses will experience this
  complication do not exist.
• Elective induction of labor or elective cesarean
  delivery for all women suspected of carrying a
  fetus with macrosomia is not appropriate.

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What Does ACOG Say?

• November, 2002. The following recommendations
  are based primarily on consensus and expert
  opinion
• In patients with a history of shoulder dystocia,
  EFW, gestational age, maternal glucose
  intolerance, and the severity of the prior
  neonatal injury should be evaluated and the risks
  and benefits of cesarean delivery discussed with
  the patient.
• Planned cesarean delivery to prevent shoulder
  dystocia may be considered for suspected fetal
  macrosomia with estimated fetal weights exceeding
  5,000 grams in women without diabetes and 4,500
  grams in women with diabetes.
• There is no evidence that any one maneuver is
  superior to another in releasing an impacted
  shoulder or reducing the chance of injury.
  However, performance of the McRoberts maneuver is
  a reasonable initial approach.

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Residents Documentation with a Simulated Shoulder
DystociaObstetrics and Gynecology, 2004.
104667-670

• Date
• Time of delivery
• Providers in the room at time of delivery
• States complication was a shoulder dystocia
• Notes which shoulder was anterior
• How long for delivery of shoulder
• Infants birth weight
• Apgar scores
• Cord gases sent?
• Mentions if infant moving all extremities after
  birth
• Notes if pediatrician called
• Estimated blood loss
• Includes all maneuvers used and order of
  maneuvers
• Notes if patient had epidural anesthesia

• Median number of key components was 8
• 76 had less than 10 key components
• 18 noted which shoulder was anterior
• 18 noted that gases were sent
• 36 noted if all extremities moving
• 46 noted how long to deliver shoulder

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HCA Shoulder Dystocia Form