Intrapartum care: Shoulder Dystocia, Mendleson's Syndrome

Question 1

What is shoulder dystocia

Answer 1

Impaction of anterior shoulder on pubic symphysis

Question 2

What are 5 pre-labour risk factors for shoulder dystocia

Answer 2

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

Question 3

What are 4 intrapartum risk factors for shoulder dystocia

Answer 3

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

Question 4

What sign may be present in shoulder dystocia

Answer 4

Turtle neck sign

Question 5

What is turtle neck sign

Answer 5

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

Question 6

What is the problem with shoulder dystocia

Answer 6

leads to foetal hypoxia

Question 7

What can shoulder dystocia correction lead to

Answer 7

lead to brachial plexus injuries

Question 8

What is the mnemonic to remember immediate management of shoulder dystocia

Answer 8

PACE

Question 9

What is immediate management of shoulder dystocia

Answer 9

Pushing - STOP

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

Call for help

Episiotomy to aid manouvere’s

Question 10

Why should a mother not push

Answer 10

Increases chance of impaction

Question 11

Why is downward traction not used

Answer 11

Increases risk brachial plexus injury

Question 12

Why should pressure not be applied to the funds

Answer 12

Increases risk uterine rupture

Question 13

What is first-line manoeuvre for shoulder dystocia

Answer 13

McRobert’s

Question 14

What is the mcrobert’s manoeuvre

Answer 14

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

Question 15

What is the aim of the mcrobert’s manoeuvre

Answer 15

Flatten sacral prometry and increase lumbro-sacral angle

Question 16

What is second line for shoulder dystocia

Answer 16

Internal manoeuvres

Question 17

Explain internal manoeuvres for shoulder dystocia

Answer 17

Place hand in vagina and reach to the posterior arm

Question 18

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

Answer 18

Roll mother onto all 4’s and try again

Question 19

What is recommended for third stage labour after should dystocia

Answer 19

Active management - to prevent PPH

Question 20

Why is a PR performed post shoulder dystocia

Answer 20

Exclude 3rd and 4th degree tears

Question 21

What needs to be assessed in the neonate following shoulder dystocia

Answer 21

• Brachial plexus injury
• Humeral head fracture
• Hypoxic brain injury

Question 22

What are 2 maternal complications of shoulder dystocia

Answer 22

PPH

3rd, 4th degree tears

Question 23

What type of paralysis does shoulder dystocia cause

Answer 23

Erb Duchenne Paralysis

Question 24

What is damaged in erb Duchenne palsy

Answer 24

C5-C6

Question 25

How will babies arm present in erb duchenne palsy

Answer 25

'Porter's tip'

Question 26

What are two risk factors for Erb's Duchenne paralysis

Answer 26

Diabetes | Breech

Question 27

What is the management or erb duchenne palsy

Answer 27

Exclude clavicular fracture | Physio

Question 28

Where is damage in klumpke's paralysis

Answer 28

T1

Question 29

How does klumpke's paralysis present

Answer 29

Loss intrinsic muscles hand

Question 30

What causes klumpke's paralysis

Answer 30

Traction

Question 31

What is mendelson's syndrome

Answer 31

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

Question 32

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

Answer 32

GA

Question 33

How is mendleson's syndrome managed

Answer 33

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