dystocia

Question 1

how much time do you have to get the baby out with a shoulder dystocia?

Answer 1

6-8 minutes before brain damage

best to get the baby out in 4-6 minutes to allow for resuscitation

Question 2

etiology for shoulder dystocia

Answer 2

large fetal shoulders
small maternal pelvis
post dates
asynclitism
OP
baby's hand behind back

Question 3

diagnosing prenatally

Answer 3

obese or diabetic moms
small, delicate mom and big father
large baby- fundal height >40cm at term
hx of large babies
hx of shoulder dystocia

Question 4

warning signs at the birth

Answer 4

Head delivers slowly – comes in jerks; always note time head delivers to let you know how long you have.
Chin stays tight to perineum (or thigh if head has rotated); may see head get sucked back in, to chin at least
Can’t find neck
Can’t see anterior shoulder, even with traction of baby’s head
Head and scalp begin to suffuse and darken with venous congestion; get purply-blue
Even more suspicious if shoulders don’t easily deliver with next contraction
May want mom to push, even without contraction, to see if anything will change.

Question 5

ddx for shoulder dystocia

Answer 5

compound presentation; multiple parts presenting at once, ie; hand under the chin (slow head delivery)
incomplete cervical dilation w/ fetal demise, macerated fetus, anencephaly. Shoulders get stuck behind cervix, not pubic bone
fetal trunk enlargement; ascites, tumor
uterine constriction ring

Question 6

methods for getting baby out

Answer 6

traction head toward mom’s back while assist applies suprapubic pressure
woods screw maneuver
flip mom to hands and knees
slide hand in to mom to try to free posterior shoulder
flex arm with pressure on antecubital fossa inside elbow
break clavicle