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Reproductive Health > Shoulder dystocia > Flashcards

Shoulder dystocia Flashcards

1
Q

At risk of shoulder dystocia

A

Cephalo-pelvic disproportion
Prev shoulder dystocia
Macorsomia
High BMI
Induction and assisted labour
Long slow labours and second stages

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2
Q

Risk for baby with shoulder dystocia

A

Hypoxia, death
Nerve injury - brachial plexus
Radial and clavicle fracture

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3
Q

When do shoulder dystocias suspected

A

Fail to advance after 2 or 3 pushes

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3
Q

When do shoulder dystocias suspected

A

Fail to advance after 2 or 3 pushes

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4
Q

HELPER

A

HELP
Episiotomy
Legs - mcroberts
Pressure
Enter manouvres
Remove posterior arm
Rollover and repeat

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5
Q

What is macroberts manouvre

A

Lift legs up to head - knees up - tilt coxix to allow pelvis to widen in order to deliver

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6
Q

What is macroberts manouvre

A

Lift legs up to head - knees up - tilt coxix to allow pelvis to widen in order to deliver

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7
Q

Pressure how do

A

Start putting pressure on abdomen like cardiac massage, straight then rocking 30s each
After each manouvre try and deliver

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8
Q

Enter manouvres

A

Push anterior shoulder back
Pull posterior shoulder forward
Do both at same time
Try each for 30s

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9
Q

What can do if HELPER doesnt work

A

Break the clavicle

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10
Q

How long to get baby out before pH drops

A

7 minutes

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11
Q

Last line of action

A

Sympisiotomy - split the pubic symphysis
HEad back in and caesarean section

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12
Q

What at risk of after shoulder dystoica?

A

PPH
PTSD

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13
Q

What is assessed in the bishop score?

A

Foetal station
Cervical position
Cervical dilatation
Cervical effacement
Cervical consistency

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14
Q

Scoring for Bishop score

A

Foetal station (0-3)
Cervical position (0-2)
Cervical dilatation (0-3)
Effacemtent (0-3)
Consistency (0-2)
Maximum score = 13

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15
Q

What score predicts successful induction of labour

A

> 8 on bishop score

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15
Q

What score predicts successful induction of labour

A

> 8 on bishop score

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16
Q

What score predicts successful induction of labour

A

> 8 on bishop score

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17
Q

What score predicts successful induction of labour

A

> 8 on bishop score

18
Q

What does a Bishop score under 8 suggest

A

Cervical ripening may be required to prepare the cervix

19
Q

What is a membrane sweep?

A

Insert a finger into cervix to stimulate cervix and begin process of labour

20
Q

When will labour start after a successful membraen sweep?

A

48 hours

21
Q

What can be inserted into the bagina to induce labour?

A

Prostagladnin E2 (dinoprostone) - gel, tablet or pessary
Releases prostaglandins over 24 hours

22
Q

What is a cervical ripening balloon?

A

Silicone balloon inserted into cervix gently inflated to dilate the cervix

23
Q

When is a cervical ripening balloon used over a PGE2?

A

Women with prev c section
Vaginal PGs have failed
Multiparous women >3 prec

24
Q

What is used if vaginal PGs cant be used or havent worked

A

Artificial rupture of membranes with an oxytocin infusion

25
Q

What is used to induce labour if intrauterine foetal death has occured?

A

Oral mifeprisotne (anti-progesterone) + misoprostol

26
Q

What is used for monitoring the induction of labour>

A

Cardiotocography (CTG) - assess foetal HR and uterine contractions before and during induciton of labour
Bishops score - progress

27
Q

Options when slow or no progress in labour

A
  • Further vaginal prostaglandins
  • Artificial rupture of membranes and oxytocin infusion
  • Cervical ripening balloon (CRB)
  • Elective caesarean section
28
Q

When should most women give birth within after labour starts

A

24 hours

29
Q

What is the main complication of vaginal PGs

A

Uterine hyperstimulation

30
Q

What happens in uterine hyperstimulation

A

Contraction of uteris is prolonged and frequent -> foetal distress and compromise

30
Q

What happens in uterine hyperstimulation

A

Contraction of uteris is prolonged and frequent -> foetal distress and compromise

31
Q

What is the criteria for uterine hyperstimulation

A

individual uterine contractions lasting more than 2 mins
>5 uterine contractions every 10 mins

32
Q

What can uterine hyperstimulation lead to?

A

Foetal compromuse w hypoxia and acidosis
Emergency C section
Uterine rupture

33
Q

Managemnet of uterine hyperstimulation

A

Remocing vaginal OGs or stopping oxytocin infusion
Tocolysis (preventing birth) with terbutaline

34
Q

What is failure of restitution

A

Head remains face down - occipito anterior - and does not turn sidewyas as expected after delivery

35
Q

Turtle-neck sign

A

Head delivered, then retracts back into vagina

36
Q

Steps to managing shoulder dystoica

A

Shout for help incl anaesthetics and paeds
Episiotomy
McRoberts
Pressure to anterior shoulder
Rubins manouvre
Woods screw manouvre
Zavanelli manouvre

37
Q

Complications of shoulder dystocia

A
  • Fetal hypoxia (and subsequent cerebral palsy)
  • Brachial plexus injury and Erb’s palsy
  • Perineal tears
  • Postpartum haemorrhage
38
Q

Zavanelli manouvre what is

A

involves pushing the baby’s head back into the vagina so that the baby can be delivered by emergency caesarean section.

39
Q

Wood screw manouvre

A

performed during a Rubins manoeuvre. The other hand is used to reach in the vagina and put pressure on the anterior aspect of the posterior shoulder. The top shoulder is pushed forwards, and the bottom shoulder is pushed backwards, rotating the baby and helping delivery. If this does not work, the reverse motion can be tried, pushing the top shoulder backwards and the bottom shoulder forwards.

40
Q

What is rubins manouvre

A

involves reaching into the vagina to put pressure on the posterior aspect of the baby’s anterior shoulder to help it move under the pubic symphysis.

41
Q

What is Mcroberts manouvre

A

involves hyperflexion of the mother at the hip (bringing her knees to her abdomen). This provides a posterior pelvic tilt, lifting the pubic symphysis up and out of the way.

42
Q

Pressure to anterior shoulder

A

Reproductive Health (69 decks)

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