Birthing Complications: SHOULDER DYSCOTIA

Question 1

Shoulder Dyscotia

Answer 1

Occurs after birth of the head.

The shoulders fail to be born with next contraction; anterior shoulder stuck on symphysis pubis.

<0.7% of births.

Additional manouvres required!!!

Question 2

Identification of SD

Answer 2

Failure of spontaneous birth of the baby’s body.

TURTLE SIGN; foetus head pulls backwards burying its head into the perineum like a turtle pulling its head back into its shell.

Question 3

Risk Factors

Answer 3

Previous SD

Large Foetus

DIabetis

Prolonged Pregnancy

Advanced Maternal Age

Previous Large Baby

Prolonged 2nd stage of labour

Question 4

Diagnosis

Answer 4

Diagnosed if baby fails to be born after next 2 contractions following complete head birth; remember there’s normally a break between though, don’t jump in too soon.

Question 5

Treatments: 30 second rule

Answer 5

Try all treatments for 30 seconds

Question 6

McRoberts

Answer 6

Lay mother flat with a pillow under her head, knees up towards her chest.

Causes natural abduction around abdomen.

One person holding up each leg.

Try for 30 seconds with axial traction to the baby’s head.

Question 7

Suprapubic Pressure

Answer 7

Identify foetal back and apply constant pressure using CPR grip; 2 fingers above symphysis pubis.

Concept is to reduce shoulder diameter for anterior shoulder to be delivered under smphysis; use axial traction.

Try for 30 seconds, if no work then use intermittent pressure like in CPR (rocking motion).

Question 8

All Fours

Answer 8

If after 30 seconds no work, turn woman onto all 4s; bottom up and head as low as possible.

Apply axial traction

If after 30 seconds no work, convey RCHT.

Question 9

Extrication

Answer 9

Get mum to walk; use blanket / sheet in between.

Walk backwards down the stairs, helps move the pelvis.

Lay mother on her right side in DCA.