Shoulder dystocia Flashcards
What is a chignon?
A chignon is a temporary swelling left on an infant’s head after a ventouse suction cap has been used to deliver him or her.[1] It is not a sign of serious injury and may take as little as two hours or as long as two weeks to disappear.
What is a cephalohaematoma?
hemorrhage of blood between the skull and the periosteum
Differs from caput
What is Caput succedaneum?
- scalp swelling that extends across the midline and over suture lines and is associated with head moulding.
- does not usually cause complications and usually resolves over the first few days.
Management of shoulder dystocia?
- Note the time of the birth of the head
- Call for help
- Evaluate the need for episiotomy
- McRobert’s Manoeuvre
- Rubins I Manoeuvre
- Rubins II manoeuvre
- Wood’s screw manoeuvre
- Reverse Woods screw manoeuvre
- Delivery of the Posterior Arm
- Rotation of the woman onto all fours
- Last resort manoeuvres
Deliberate fracture of the clavicle
Symphysiotomy
Zavanelli manoeuvre (midwife to give a tocolytic
- Assess for Consequences
- Documentation
- Debriefing
Describe McRoberts Manoeuvre
- flex and abduct the maternal hips
- position the thighs up onto her abdomen.
works 90% of the time
Describe Rubins 1 Manoeuvre
while the woman is placed in the McRobert’s position:
- Place both hands suprapubically over the posterior aspect of the fetal shoulder, and apply continuous pressure in a downward lateral motion
- Next apply the pressure in a rocking intermittent motion.
- Gentle traction should be applied
Describe Rubins 2 Manoeuvre
- Insert the hand into the vagina posteriorly
- sweep two fingers up to the posterior aspect of the anterior shoulder
- push it into the oblique diameter of the pelvis.
WHAT ARE THE 4 WARNING SIGNS FOR SHOULDER DYSTOCIA?
Difficulty with birth of the face and chin
The fetal head retracts against the perineum. Referred to as the ‘turtle’ sign.2
Failure of the fetal head to restitute.1
Failure of the shoulders to descend.
What needs to be documented in Shoulder dystocia?
- time of birth of the head
- direction the head was facing after restitution
- type of manoeuvres used, timing and sequence
- time of delivery of the body
- time help was called for
- staff in attendance and their arrival time
- condition of the baby at birth
- arterial umbilical cord blood acid base balance
Why is McRoberts manoeuvre performed?
- position flattens the sacral promontory and results in cephalad rotation of the pubic symphysis.
- It is associated with an increase in uterine
pressure and amplitude of the contractions.
Why is Rubins II manoeuvre performed?
This manoeuvre adducts the fetal
shoulder girdle, reducing the diameter
and rotating the shoulders forward into
the oblique diameter.4
Why is Rubins I manoeuvre performed?
Supra pubic pressure improves the success rate when applied with the McRobert’s manoeuvre by reducing the bisacromial diameter and rotating the anterior shoulder into the oblique diameter.
What is Wood’s screw manoeuvre?
While performing Rubins II
- enter the vagina and apply pressure with two
fingers to the anterior aspect of the posterior shoulder
- maintaining rotation in the original direction
- If this manoeuvre is unsuccessful then the accoucheur moves onto thereverse Woods screw manoeuvre.
How is reverse Wood’s screw manoeuvre performed?
- Apply pressure to the posterior aspect of the posterior shoulder
- attempt to rotate it through 180° in the opposite direction to the Woods screw manoeuvre.
What are the risk factors for shoulder dystocia?
- Suspected macrosomia
- Operative vaginal birth
- Type 1 & Type 2 Diabetes
- Precipitate birth
- Maternal Obesity BMI
- age greater than 30
- Prolonged active phase in first stage of labour
- Post-dates pregnancy
- Prolonged second stage
- Previous shoulder dystocia
- Short stature
- Gestational Diabetes
