Shoulder dystocia Flashcards
How common is shoulder dystocia
0.2-3%
What is the risk of 4750-5000g resulting in shoulder dystocia
20%
RFs for shoulder dystocia
Maternal:
- High BMI
- Diabetes
- Abnormal pelvic activity
- Post dates pregnancy
- Male gender fetus
- Short maternal stature
Fetal:
- Macrosomia >4.5kg
- Previous shoulder dystocia
Intrapartum risk factors for shoulder dystocia
Labour dystocia
Assisted vaginal delivery
Epidural anaesthesia
Prolonged second stage
What are the neonatal complications of shoulder dystocia
brachial plexus injury - erb’s palsy C5/6
Klumpke’s palsy C8T1
What are the 3 aims of the manoeuvres for shoulder dystocia?
Decrease the bisaromial diameter
increase the functional size of the bony pelvis
Change the relationship of the shoulders to the woman’s bony pelvis
What is the HELPERR acronym
Call for HELP
Evaluate for EPISIOTOMY
LEGS McRobert’s
Suprapubic PRESSURE
ENTER internal menoeuvres - Rubins II, Woodscrew and reverse woodscrew
REMOVE the posterior arm
ROLL the patient
How to do suprapubic pressure
Anterior shoulder posterior aspect push the shoulder down and out.
Pressure should be constant then use a rocking motion
What is rubins I
What is rubins II
rubins 1 - push anterior shoulder
rubins 2 - push posterior shoulder
How to do removal of the posterior arm
pringle can hand in in front of baby’s chest to flex the arm at the acf and then get the wrist and bring over baby’s face and head. usually causes baby to rotate
Which is the best thing after mcroberts and suprapubic pressure
removal of posterior arm - lowest rate injury and highest rate success
What to do after you have tried all the manoeuvres
Turn onto hands and knees - can dislodge baby
What to do before trying the crazy manoeuvres
Try them all again. If they then fail a second time can do onto the crazy stuff
What are the crazy manoeuvres
Posterior arm sling - using two middle fingers to form a sling and bring the arm upwards.
Zavanelli - repacing the fetal head. De-restitution
Clavicular fracture
Symphysiotomy
