Shoulder Dystocia Flashcards
What might alert you to the possibility of SD?
Prolonged 1st/2nd stage
Instrumental
Augmentation
What are the red flags that warn you?
- Head doesn’t restitute
- Slow emergence of face + chin
- Anterior shoulder doesn’t descend with maternal effort and/or when routine axial traction applied
- Head retracts depressing the perineum (turtle neck)
- Head remaining tightly applied to vulva, no nape of neck visible
After birth of head, how long should you wait until applying diagnostic axial traction?
Wait until the next contraction
Once SD confirmed, what should you tell the Mother?
DISCOURAGE PUSHING
Get her to move so her buttocks are at the edge of the bed and lie her flat
Name the first manoeuvre
McRoberts (knees to ears)
How long do you have to resolve a SD?
About 5 mins
When should an episiotomy be CONSIDERED?
before commencing internal manoeuvres, if you can’t get hand into vagina without causing significant trauma.
(won’t help deliver baby!)
What is the first internal manoeuvre that you do to release posterior arm?
Pringle fingers into sacral hollow
Locate posterior shoulder
Follow humerus down to elbow
Pressure on antecubital fossa will flex forearm so can be swept across chest
Grab wrist and pull posterior arm out in straight line
(Suprapubic pressure whilst this is happening)
Describe internal rotation step 1
Put pressure on front of posterior shoulder to try and rotate fetus to oblique diameter
(Suprapubic pressure applied)
Internal rotation step 2
Move fingers round
Apply pressure to back of posterior shoulder
(NO suprapubic pressure)
Internal rotation step 3
Slide hand/fingers up to anterior shoulder
Put pressure on back of anterior shoulder
If there is still nothing after internal manoeuvres what manoeuvre can be done next?
Gaskins manoeuvre- roll her onto all 4’s
Attempt internal manoeuvres again
Deliver posterior shoulder first
If still nothing after rolling to all 4’s, what 3 additional manoeuvres can be done?
- Zavanelli- pushes fetal head back into birth canal
- Symphysiotomy- outdated, cartilage divided by scalpel
- Cleidotomy- 1+ clavicles broken
Once resolved and baby delivered what should happen?
NLS/ neonatologist r/w
Active 3rd stage- increased risk of PPH
Cord gases