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Obstetrics > Intrapartum care: Shoulder Dystocia, Mendleson's Syndrome > Flashcards

Intrapartum care: Shoulder Dystocia, Mendleson's Syndrome Flashcards

1
Q

What is shoulder dystocia

A

Impaction of anterior shoulder on pubic symphysis

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2
Q

What are 5 pre-labour risk factors for shoulder dystocia

A
  1. Maternal Diabetes
  2. BMI >30
  3. Macrosomia
  4. Previous dystocia
  5. Induction labour
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3
Q

What are 4 intrapartum risk factors for shoulder dystocia

A
  1. Prolonged first stage
  2. Secondary arrest
  3. Induction w/oxytocin
  4. Instrumental delivery
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4
Q

What sign may be present in shoulder dystocia

A

Turtle neck sign

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5
Q

What is turtle neck sign

A

foetus head retracts back into the pelvis, neck is no longer visible

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6
Q

What is the problem with shoulder dystocia

A

leads to foetal hypoxia

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7
Q

What can shoulder dystocia correction lead to

A

lead to brachial plexus injuries

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8
Q

What is the mnemonic to remember immediate management of shoulder dystocia

A

PACE

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9
Q

What is immediate management of shoulder dystocia

A

Pushing - STOP

Axial traction, not downwards. Do not apply fundal pressure.

Call for help

Episiotomy to aid manouvere’s

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10
Q

Why should a mother not push

A

Increases chance of impaction

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11
Q

Why is downward traction not used

A

Increases risk brachial plexus injury

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12
Q

Why should pressure not be applied to the funds

A

Increases risk uterine rupture

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13
Q

What is first-line manoeuvre for shoulder dystocia

A

McRobert’s

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14
Q

What is the mcrobert’s manoeuvre

A

Ask women to flex hips and knees up, stop pushing and apply suprapubic pressure.

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15
Q

What is the aim of the mcrobert’s manoeuvre

A

Flatten sacral prometry and increase lumbro-sacral angle

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16
Q

What is second line for shoulder dystocia

A

Internal manoeuvres

17
Q

Explain internal manoeuvres for shoulder dystocia

A

Place hand in vagina and reach to the posterior arm

18
Q

If Mcrobert’s and internal manoeuvres fail what should be done

A

Roll mother onto all 4’s and try again

19
Q

What is recommended for third stage labour after should dystocia

A

Active management - to prevent PPH

20
Q

Why is a PR performed post shoulder dystocia

A

Exclude 3rd and 4th degree tears

21
Q

What needs to be assessed in the neonate following shoulder dystocia

A
  • Brachial plexus injury
  • Humeral head fracture
  • Hypoxic brain injury
22
Q

What are 2 maternal complications of shoulder dystocia

A

PPH

3rd, 4th degree tears

23
Q

What type of paralysis does shoulder dystocia cause

A

Erb Duchenne Paralysis

24
Q

What is damaged in erb Duchenne palsy

A

C5-C6

25
Q

How will babies arm present in erb duchenne palsy

A

‘Porter’s tip’

26
Q

What are two risk factors for Erb’s Duchenne paralysis

A

Diabetes

Breech

27
Q

What is the management or erb duchenne palsy

A

Exclude clavicular fracture

Physio

28
Q

Where is damage in klumpke’s paralysis

A

T1

29
Q

How does klumpke’s paralysis present

A

Loss intrinsic muscles hand

30
Q

What causes klumpke’s paralysis

A

Traction

31
Q

What is mendelson’s syndrome

A

Aspiration of gastric contents when under general anaesthetic in pregnancy leading to pulmonary oedema, bronchospasm and tachycardia

32
Q

What type of anesthetic must a patient be under for mendelson’s syndrome

A

GA

33
Q

How is mendleson’s syndrome managed

A
  • Tilt head down
  • Turn head to side and aspirate
  • IV hydrocortisone state
  • IV aminophylline slow infusion
  • Bronchoscope to remove gastric contents
  • Antibiotics

Obstetrics (27 decks)

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