OBS: Perinatal Medicine -- Abnormal Progress of Labour

Question 1

Management of shoulder dystocia

Answer 1

1. H Call for help: senior obstetricians, anaesthetists, neonatologists, OT
2. E +/- Episiotomy for entry of obstetrician’s hand for internal rotation
3. Leg McRoberts’ maneuver:
   
   • flex & abduct hip *hyperflex thigh against abdomen* + gentle downward traction of fetal head
4. Pressure Rubin I maneuver
   
   • apply downward & lateral pressure above pubic symphysis, from the side of fetal back
5. Entry Internal rotational maneuvers
   
   • insert fingers into vagina to reach shoulder → attempt to rotate
     1. Rubin II maneuver (anterior shoulder)
     2. Wood’s screw (posterior shoulder)
6. R Remove posterior arm
7. Roll All fours position
   
   • attempt internal rotation & delivery of posterior arm in this position

Question 2

External maneuvres for managing shoulder dystocia

Answer 2

McRoberts maneuvre, Robert I maneuvre

Question 3

Internal maneuvres for managing shoulder dystocia

Answer 3

Robin II maneuvre, Woodscrew maneuvre

Question 4

Warning signs for shoulder dystocia

Answer 4

• Turtle sign,
• Lack of restitution,
• Failed downward traction to deliver shoulder,
• Anterior shoulder not palpable after head delivery

Question 5

Neonatal complications of shoulder dystocia

Answer 5

Fetal hypoxia / birth asphyxia, Erb’s palsy, Clavicle / humerus fracture

Question 6

Risk factors for shoulder dystocia

Answer 6

Macrosomia, GDM, Maternal obesity

Question 7

Which structures are torn in 3rd and 4th degree perineal tear compared to 2nd degree?

Answer 7

3rd: anal sphincter, 4th: anorectal mucosa

Question 8

Complications of perineal tear

Answer 8

• PPH
• Fecal incontinence, Ano-vaginal fistula, Pelvic organ prolapse
• Would infection, dehiscence, Dyspareunia, Pelvic pain

Question 9

Post-operative management of obstetric anal sphincter injury

Answer 9

1. Broad-spectrum Abx *↓ risk of wound infection & dishecence*
2. Laxatives + Low residue diet *↓ risk of wound dishecence*
3. PT / Pelvic floor exercise
4. FU at 6~12w