Intrapartum care: Shoulder Dystocia, Mendleson's Syndrome Flashcards
What is shoulder dystocia
Impaction of anterior shoulder on pubic symphysis
What are 5 pre-labour risk factors for shoulder dystocia
- Maternal Diabetes
- BMI >30
- Macrosomia
- Previous dystocia
- Induction labour
What are 4 intrapartum risk factors for shoulder dystocia
- Prolonged first stage
- Secondary arrest
- Induction w/oxytocin
- Instrumental delivery
What sign may be present in shoulder dystocia
Turtle neck sign
What is turtle neck sign
foetus head retracts back into the pelvis, neck is no longer visible
What is the problem with shoulder dystocia
leads to foetal hypoxia
What can shoulder dystocia correction lead to
lead to brachial plexus injuries
What is the mnemonic to remember immediate management of shoulder dystocia
PACE
What is immediate management of shoulder dystocia
Pushing - STOP
Axial traction, not downwards. Do not apply fundal pressure.
Call for help
Episiotomy to aid manouvere’s
Why should a mother not push
Increases chance of impaction
Why is downward traction not used
Increases risk brachial plexus injury
Why should pressure not be applied to the funds
Increases risk uterine rupture
What is first-line manoeuvre for shoulder dystocia
McRobert’s
What is the mcrobert’s manoeuvre
Ask women to flex hips and knees up, stop pushing and apply suprapubic pressure.
What is the aim of the mcrobert’s manoeuvre
Flatten sacral prometry and increase lumbro-sacral angle
What is second line for shoulder dystocia
Internal manoeuvres
Explain internal manoeuvres for shoulder dystocia
Place hand in vagina and reach to the posterior arm
If Mcrobert’s and internal manoeuvres fail what should be done
Roll mother onto all 4’s and try again
What is recommended for third stage labour after should dystocia
Active management - to prevent PPH
Why is a PR performed post shoulder dystocia
Exclude 3rd and 4th degree tears
What needs to be assessed in the neonate following shoulder dystocia
- Brachial plexus injury
- Humeral head fracture
- Hypoxic brain injury
What are 2 maternal complications of shoulder dystocia
PPH
3rd, 4th degree tears
What type of paralysis does shoulder dystocia cause
Erb Duchenne Paralysis
What is damaged in erb Duchenne palsy
C5-C6
How will babies arm present in erb duchenne palsy
‘Porter’s tip’
What are two risk factors for Erb’s Duchenne paralysis
Diabetes
Breech
What is the management or erb duchenne palsy
Exclude clavicular fracture
Physio
Where is damage in klumpke’s paralysis
T1
How does klumpke’s paralysis present
Loss intrinsic muscles hand
What causes klumpke’s paralysis
Traction
What is mendelson’s syndrome
Aspiration of gastric contents when under general anaesthetic in pregnancy leading to pulmonary oedema, bronchospasm and tachycardia
What type of anesthetic must a patient be under for mendelson’s syndrome
GA
How is mendleson’s syndrome managed
- Tilt head down
- Turn head to side and aspirate
- IV hydrocortisone state
- IV aminophylline slow infusion
- Bronchoscope to remove gastric contents
- Antibiotics
