Shoulder Dystocia Flashcards
1
Q
Definition
A
Vaginal cephalic delivery requiring additional obstetric manoeuvres to delivery fetus shoulders after delivery of head and gentle traction failed (RCOG, 2012).
TIME CRITICAL EMERGENCY
2
Q
Incidence
A
0.1% - 3% of all births. 50% of cases have birth weight below 4000g
3
Q
Risk factors
A
- Previous shoulder dystocia
- Macrosomia > 4000g
- Gestational age
- GDM
- Obesity BMI > 30
- Prolonged 1st/2nd Stage
- Operative vaginal birth
4
Q
Help
A
Senior Midwife - Aware of ward activity Senior OBS - Experienced and knowledge Anaesthetist - In case we need to go theatre Scribe - To document everything Paediatric - To assess baby condition Runner - To get equipment
5
Q
Recognition
A
- Prolonged crowning/restitution
- Prolonged head bobbing
- Difficulty with birth of face and chin
- Turtle neck sign, chin retracts and depress perineum
6
Q
Principle management
A
- Maximise pelvic dimension space for shoulders
- Adduct shoulder
- Change alignment of shoulders to pass through widest diameter of pelvis
7
Q
McRoberts position
A
- Lay women flat
- flex hips and knees to chest and apply axial traction to fetal head to assess if successful
Increases AP diameter, flattens sacrum and flexes fetal spine
8
Q
All fours position
A
Position women in exaggerated in all fours to increase pelvic diameter
9
Q
Suprapubic pressure
A
- Apply pressure from side of fetal back which reduces diameter of shoulders by adducting shoulders
- Apply pressure above symphysis pubis onto posterior aspect of anterior shoulder using CPR grip
Apply axial traction
10
Q
Episiotomy
A
To aid in internal manouvres
11
Q
Internal manouvres
A
- Delivery of posterior arm
- Internal rotational manouvre
12
Q
Delivery of posterior arm
A
- Reduces diameter of fetal shoulders
- Pringle hands into vagina
- Feel for hand and forearm, take hold of wrist with fingers
- Release posterior arm in straight line
- Once arm delivered apply axial traction
- If arm across body, flex antecubital fossa and grab wrists
13
Q
Internal rotational manouvres
A
- Move shoulders out of the narrowest diameter into widest diameter
- Pringle hands press on anterior or posterior aspect of posterior shoulder
- Rotation moves shoulder into wider oblique pelvis and perform axial traction
- If one direction doesn’t work try opposite direction
14
Q
Additional manouvres
A
- Performed by consultant
- Deliberate clavicle fracture with direct upwards pressure on clavicle
- Zavanelli manouvre, cephalic replacement by C/S
- Symphysiotomy, division of symphysis pubis
15
Q
Aftercare
A
- Active management of third stage
- Psychological care, perform debreif
- Perform resus, skin to skin, early feed, cord gases, Vit k
- Maternal normal post labour observations
