SHOULDER DYSTOCIA Flashcards
What is the definition of Shoulder Dystocia?
an obstetric emergency, whereby the fetal anterior shoulder becomes trapped behind the symphysis pubis. (Shah, 2016)
What is the incidence rate of Shoulder Dystocia?
1 in 150 / 0.7% vaginal deliveries.
What antenatal risk factors are there?
GDM
Raised BMI
Previous shoulder dystocia or LGA (Macrosomia)
What intrapartum risk factors are there?
IOL
Assisted Delivery
What supporting evidence is there regarding obesity and shoulder dystocia?
Vetterlain et al. (2021) 19/1000 of obese women encountered shoulder dystocia.
What are some warning signs that Shoulder Dystocia may occur?
The fetal head took long to advance.
Chin has difficulty sweeping perineum.
First steps taken when Shoulder Dystocia occurs?
Call for help (SOAPS).
Discourage pushing.
Move mother to edge of bed.
Who are SOAPS?
Senior midwife Obstetrician Anaesthetist (sometimes) Paeds/Neonatologist Scribe
What is the need for SOAPS?
Senior midwife and Obstetrician for expertise.
Anaesthetist is sometimes needed in case further emergency develops.
Paeds/Neonatologist to attend to baby after birth.
Scribe to ensure accurate detail in notes.
Second stage taken when Shoulder Dystocia occurs?
McRoberts Manoeuver and Suprapubic pressure.
What is the McRoberts manoeuver?
Knees to chest manoeuver, as it widens the pelvic outlet and flattens the sacral promontory and thus increases lumbosacral angle.
What is the effectiveness rate of McRoberts manoeuver?
40% success rate - Gesner (2020)
24.8% success rate - PROMPT (2017)
What is suprapubic pressure?
Pressure is applied to the maternal lower abdomen over the pubic bone and a rocking motion is used to release the shoulder.
What is the effectiveness of McRoberts and Suprapubic pressure?
90% success rate - Diaz (2020).
Third stage taken when Shoulder Dystocia occurs?
Delivery of the posterior arm.
How is delivery of the posterior arm performed?
Pressure on the antecubital fossa causes fetus to flex elbow in front of the body -> grasp posterior hand and sweep arm across the chest -> deliver the arm
What happens after delivery of the arm?
Rotate the fetus into oblique diameter -> bring anterior shoulder under the symphysis pubis.
If 1-3 fail, what is the next step?
Internal manoeuvers commence: Rubins II and Wood’s screw.
What is Rubins II manoeuver?
Pressure on the posterior aspect of the anterior shoulder pushes arm towards chest -> causes shoulders to rotate forwards -> downwards traction
What is Woods Screw manoeuver?
Both hands uses -> 1 in Rubins II manoeuver, 2nd places pressure on anterior aspect of posterior shoulder -> move into oblique diameter -> deliver.
After delivery, what should happen?
Neonate to be checked over
Debrief, Documentation, & Datix
What is % of PPH after delivery?
11% - RCOG, (2012)
What is the % of Brachial Plexus Injury?
Up to 16% - Yenigul, (2020)
