Obs: L&D - shoulder dystocia & cord prolapse Flashcards
what is a cord prolapse?
when the umbilical cord descends below the presenting part of the fetus and through the cervix into the vagina, after rupture of the fetal membranes
what is the danger associated with cord prolapse?
presenting part compressing the cord = fetal hypoxia
what is the most significant risk factor for cord prolapse?
when the fetus is in an abnormal lie after 37 weeks gestation
this provides space for cord to prolapse below the presenting part
(in cephalic lie, head typically descends into pelvis without room for cord to descend)
how is cord prolapse diagnosed?
suspect when there are signs of fetal distress on CTG
diagnosed by vaginal examination
how is cord prolapse managed?
emergency CS (normal delivery has high risk of cord compression and significant hypoxia)
pushing cord back is not recommended - should be kept warm and wet with minimal handling as handling causes vasospasm
presenting part can be pushed back
woman can lie in left lateral position or knee-chest position using gravity to draw fetus away from pelvis to reduce compression
tocolytic medication to minimise contractions can be given while waiting for CS
what is shoulder dystocia?
when the anterior shoulder of the baby becomes stuck behind the pubic symphysis of the pelvis after the head has been delivered
how does shoulder dystocia present?
difficulty delivering the face and head and obstruction in delivering the shoulders after delivery of the head
may be failure of restitution - where head remains face downwards and does not turn sideways as expected after delivery of the head
what is turtle neck sign in shoulder dystocia?
where the head is delivered but then retracts back into the vagina
how is shoulder dystocia managed? name the manoeuvres
obstetric emergency
episiotomy - not always done, enlarges vaginal opening and reduces risk of tears
McRoberts manoeuvre - hyperflexion of the mother at the hip - posterior pelvic tilt, lifting the pubic symphysis up and out the way
pressure to the anterior shoulder - involves pressing on the suprapubic region of the abdomen - encourages babys shoulder to move down under the pubic symphysis
Rubins manoeuvre - reaching into vagina to put pressure on posterior aspect of babys anterior shoulder to help it move under the PS
Wood’s screw manoeuvre - during rubins manoeuvre, other hand to put pressure on anterior aspect of posterior shoulder to rotate baby. reverse motion can be done
Zavanelli manoeuvre - involves pushing baby’s head back into vagina so baby can be delivered by CS
what are the complications of shoulder dystocia?
- Fetal hypoxia (and subsequent cerebral palsy)
- Brachial plexus injury and Erb’s palsy
- Perineal tears
- Postpartum haemorrhage
