Shoulder dystocia Flashcards
what is shoulder dystocia?
where the anterior shoulder of the baby gets trapped behind the pubic symphysis (after delivery of the head)
common cause of shoulder dystocia
macrosomia
3 maternal risk factors for shoulder dystocia
gestational diabetes
high maternal BMI
prolonged labour
first sign that shoulder dystocia may be occuring
failure of restitution of the head i.e. the head remains face down after delivery rather than turning around as would be expected
what is the “turtle neck sign”?
where the baby’s head is delivered and then retracts into the vagina
after calling for help, what is the first step in the management of shoulder dystocia?
rapid episiotomy (this is done to enable later manoeuvres but does not in of itself solve the problem)
first line management of shoulder dystocia
McRoberts manoeuvre
lying flat on the bed with knees tucked into the chest
how commonly is McRoberts manoeuvre successful?
90%
McRobert’s: hips adducted or abudcted?
abduction
management of shoulder dystocia if McRoberts fails
pressure on the anterior shoulder i.e. just above the pubic symphysis
what is Rubin’s manoeuvre?
reaching into the vagina in order to put pressure on the posterior aspect of the baby’s shoulder
what is Wood’s screw manoeuvre?
Rubin’s manoeuvre PLUS
reaching the other hand inside the vagina (!!!) and applying anterior pressure to the posterior shoulder with the aim of rotating the baby until it is in a suitable position for delivery
what is the Zavanelli manoeuvre?
pushing the baby back inside the uterus to be delivered by emergency caesarean (lol good luck with that)
2 complications of shoulder dystocia for the mother
perineal tears
post-partum haemorrhage
2 complications of shoulder dystocia for the neonate
foetal hypoxia
brachial plexus injuries (most commonly Erb’s palsy)
