OBS: Perinatal Medicine -- Abnormal Progress of Labour

Question 1

Management of shoulder dystocia

Answer 1

1. H: Call for help (O&G MO, Paediatrician, Anaesthetist, OT)
2. E: Episiotomy
3. L: McRoberts Maneuvre
4. P: Robin I Maneuvre
5. E: Robin II / Woodscrew Maneuvre
6. R: Posterior arm delivery
7. R: Roll the patient to four 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, Four position

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: rectal mucosa

Question 8

Complications of perineal tear

Answer 8

PPH, wound infection, genital prolapse, fetal incontinence

Question 9

Post-operative management of obstetric anal sphincter injury

Answer 9

• Broad-spectrum antibiotics
• Laxatives
• PT / Pelvic floor exercise
• Review 6~12w post-partum