SHOULDER DYSTOCIA Flashcards
What is the golden time for managing shoulder dystocia?
5 minutes. Beyond this, the fetus is prone to hypoxia and injury.
What is the incidence of shoulder dystocia?
0-1.3%.
What is the hallmark sign of shoulder dystocia?
Turtle’s sign.
What occurs during shoulder dystocia?
The anterior shoulder becomes obstructed by the maternal pubic bone after the head is delivered.
What are potential fetal complications of shoulder dystocia?
Fetal asphyxia, brachial plexus injury, and clavicular fracture.
What are risk factors for shoulder dystocia?
Previous history, macrosomia, maternal diabetes, obesity, prolonged labor, and narrow pelvis.
What fetal weight is considered macrosomia in diabetic mothers?
Greater than 4 kg.
What fetal weight is considered macrosomia in non-diabetic mothers?
Greater than 4.2 kg.
What should be avoided during shoulder dystocia management (4Ps)?
Pulling, pushing, panicking, and pivoting the head.
What does the acronym HELPERR stand for in shoulder dystocia management?
H: Help, E: Evaluate for episiotomy, L: Legs (McRoberts maneuver), P: Pressure (suprapubic), E: Enter (rotational maneuvers), R: Remove the posterior arm, R: Roll the patient to hands and knees.
What does the acronym ALARMER stand for in shoulder dystocia management?
A: Ask for help, L: Lift/hyperflex (McRoberts), A: Anterior shoulder disimpaction, R: Rotate posterior shoulder, M: Manual removal of posterior arm, E: Episiotomy, R: Roll into all fours.
What is the purpose of the McRoberts maneuver?
To increase the pelvic diameter and change the angle of the birth canal to dislodge the shoulder.
How is suprapubic pressure applied to manage shoulder dystocia?
By pressing down on the pubic bone to help dislodge the anterior shoulder.
What maneuver is used for anterior shoulder disimpaction?
Mazzanti maneuver or Rubin’s maneuver.
What maneuver is used for posterior shoulder rotation?
Wood’s or Screw maneuver.
What is the Gaskin maneuver?
The mother is placed on all fours to increase pelvic diameter and relieve pressure on the shoulders.
What is the Zavanelli maneuver?
Cephalic replacement by reversing the cardinal movements of labor followed by cesarean delivery.
What are the cardinal movements of labor (ED FIRERE)?
Engagement, Descend, Flexion, Internal Rotation, External Rotation, Extension.
What should be done if all maneuvers fail to resolve shoulder dystocia?
Deliberate fracture of the clavicle, symphysiotomy, or Zavanelli maneuver followed by cesarean delivery.
What are maternal complications of shoulder dystocia?
Postpartum hemorrhage, uterine rupture, and trauma from maneuvers.
What percentage of shoulder dystocia cases lead to postpartum hemorrhage?
11%, due to uterine atony and lacerations.
What are neonatal complications of shoulder dystocia?
Hypoxia, brachial plexus injury, clavicular fracture, and increased neonatal morbidity.
How is the third stage of labor managed after shoulder dystocia?
Actively manage the stage, conduct cord blood gas analysis, and ensure neonatal resuscitation.
Why is timely and accurate documentation important in shoulder dystocia?
To prevent litigation and ensure proper medical records.
What team members should be called during a shoulder dystocia emergency?
Obstetrician, pediatrician, anesthesiologist, and nursing staff.
What does the McRoberts maneuver specifically do to help manage shoulder dystocia?
It flattens the sacrum and increases the pelvic inlet space to help dislodge the shoulder.
What is the function of suprapubic pressure in shoulder dystocia?
To dislodge the anterior shoulder from behind the pubic bone.
What is Rubin’s maneuver?
Adduction of the most accessible shoulder to move the fetus into an oblique position and reduce the bisacromial diameter.
What is the Wood’s screw maneuver?
Abduction of the posterior shoulder by exerting pressure on the anterior surface of the posterior shoulder.
What is the purpose of manual rotation of the posterior arm in shoulder dystocia?
To rotate the posterior shoulder and allow it to emerge more easily.
When is the Gaskin maneuver most effective?
When other maneuvers have failed, as it increases pelvic diameter and changes the angle of the birth canal.
What is a potential last-resort solution for shoulder dystocia?
Deliberate fracture of the clavicle to reduce shoulder width.
What is symphysiotomy, and when is it performed?
It is the surgical division of the pubic symphysis, performed in extreme cases of shoulder dystocia.
What are strategies to prevent shoulder dystocia?
Regular prenatal monitoring, early identification of macrosomia, and elective cesarean delivery in high-risk cases.
What are the common maternal risk factors for shoulder dystocia?
Obesity, diabetes, narrow pelvis, and history of prolonged labor.
What is the pathophysiology of shoulder dystocia?
The anterior shoulder becomes lodged against the maternal pubic bone, obstructing delivery.
Why is neonatal resuscitation critical after shoulder dystocia?
To address potential hypoxia and birth injuries sustained during delivery.
How does obesity increase the risk of shoulder dystocia?
By altering pelvic dimensions and adding fatty tissue that impedes fetal descent.
What is the importance of prenatal counseling for shoulder dystocia?
To prepare parents for potential complications and reduce anxiety.
