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OBSTETRICS > SHOULDER DYSTOCIA > Flashcards

SHOULDER DYSTOCIA Flashcards

1
Q

What is the golden time for managing shoulder dystocia?

A

5 minutes. Beyond this, the fetus is prone to hypoxia and injury.

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2
Q

What is the incidence of shoulder dystocia?

A

0-1.3%.

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3
Q

What is the hallmark sign of shoulder dystocia?

A

Turtle’s sign.

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4
Q

What occurs during shoulder dystocia?

A

The anterior shoulder becomes obstructed by the maternal pubic bone after the head is delivered.

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5
Q

What are potential fetal complications of shoulder dystocia?

A

Fetal asphyxia, brachial plexus injury, and clavicular fracture.

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6
Q

What are risk factors for shoulder dystocia?

A

Previous history, macrosomia, maternal diabetes, obesity, prolonged labor, and narrow pelvis.

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7
Q

What fetal weight is considered macrosomia in diabetic mothers?

A

Greater than 4 kg.

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8
Q

What fetal weight is considered macrosomia in non-diabetic mothers?

A

Greater than 4.2 kg.

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9
Q

What should be avoided during shoulder dystocia management (4Ps)?

A

Pulling, pushing, panicking, and pivoting the head.

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10
Q

What does the acronym HELPERR stand for in shoulder dystocia management?

A

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.

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11
Q

What does the acronym ALARMER stand for in shoulder dystocia management?

A

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.

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12
Q

What is the purpose of the McRoberts maneuver?

A

To increase the pelvic diameter and change the angle of the birth canal to dislodge the shoulder.

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13
Q

How is suprapubic pressure applied to manage shoulder dystocia?

A

By pressing down on the pubic bone to help dislodge the anterior shoulder.

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14
Q

What maneuver is used for anterior shoulder disimpaction?

A

Mazzanti maneuver or Rubin’s maneuver.

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15
Q

What maneuver is used for posterior shoulder rotation?

A

Wood’s or Screw maneuver.

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16
Q

What is the Gaskin maneuver?

A

The mother is placed on all fours to increase pelvic diameter and relieve pressure on the shoulders.

17
Q

What is the Zavanelli maneuver?

A

Cephalic replacement by reversing the cardinal movements of labor followed by cesarean delivery.

18
Q

What are the cardinal movements of labor (ED FIRERE)?

A

Engagement, Descend, Flexion, Internal Rotation, External Rotation, Extension.

19
Q

What should be done if all maneuvers fail to resolve shoulder dystocia?

A

Deliberate fracture of the clavicle, symphysiotomy, or Zavanelli maneuver followed by cesarean delivery.

20
Q

What are maternal complications of shoulder dystocia?

A

Postpartum hemorrhage, uterine rupture, and trauma from maneuvers.

21
Q

What percentage of shoulder dystocia cases lead to postpartum hemorrhage?

A

11%, due to uterine atony and lacerations.

22
Q

What are neonatal complications of shoulder dystocia?

A

Hypoxia, brachial plexus injury, clavicular fracture, and increased neonatal morbidity.

23
Q

How is the third stage of labor managed after shoulder dystocia?

A

Actively manage the stage, conduct cord blood gas analysis, and ensure neonatal resuscitation.

24
Q

Why is timely and accurate documentation important in shoulder dystocia?

A

To prevent litigation and ensure proper medical records.

25
Q

What team members should be called during a shoulder dystocia emergency?

A

Obstetrician, pediatrician, anesthesiologist, and nursing staff.

26
Q

What does the McRoberts maneuver specifically do to help manage shoulder dystocia?

A

It flattens the sacrum and increases the pelvic inlet space to help dislodge the shoulder.

27
Q

What is the function of suprapubic pressure in shoulder dystocia?

A

To dislodge the anterior shoulder from behind the pubic bone.

28
Q

What is Rubin’s maneuver?

A

Adduction of the most accessible shoulder to move the fetus into an oblique position and reduce the bisacromial diameter.

29
Q

What is the Wood’s screw maneuver?

A

Abduction of the posterior shoulder by exerting pressure on the anterior surface of the posterior shoulder.

30
Q

What is the purpose of manual rotation of the posterior arm in shoulder dystocia?

A

To rotate the posterior shoulder and allow it to emerge more easily.

31
Q

When is the Gaskin maneuver most effective?

A

When other maneuvers have failed, as it increases pelvic diameter and changes the angle of the birth canal.

32
Q

What is a potential last-resort solution for shoulder dystocia?

A

Deliberate fracture of the clavicle to reduce shoulder width.

33
Q

What is symphysiotomy, and when is it performed?

A

It is the surgical division of the pubic symphysis, performed in extreme cases of shoulder dystocia.

34
Q

What are strategies to prevent shoulder dystocia?

A

Regular prenatal monitoring, early identification of macrosomia, and elective cesarean delivery in high-risk cases.

35
Q

What are the common maternal risk factors for shoulder dystocia?

A

Obesity, diabetes, narrow pelvis, and history of prolonged labor.

36
Q

What is the pathophysiology of shoulder dystocia?

A

The anterior shoulder becomes lodged against the maternal pubic bone, obstructing delivery.

37
Q

Why is neonatal resuscitation critical after shoulder dystocia?

A

To address potential hypoxia and birth injuries sustained during delivery.

38
Q

How does obesity increase the risk of shoulder dystocia?

A

By altering pelvic dimensions and adding fatty tissue that impedes fetal descent.

39
Q

What is the importance of prenatal counseling for shoulder dystocia?

A

To prepare parents for potential complications and reduce anxiety.

OBSTETRICS (13 decks)

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