Shoulder Dystocia Flashcards
Can shoulder dystocia be predicted?
- Clinicians should be aware of existing risk factors in labouring women and must always be alert to possibility of shoulder dystocia.
- Risk assessments for the prediction of shoulder dystocia are insufficiently predictive to allow prevention
of the large majority of cases.
Factors associated with shoulder dystocia
PRE-LABOUR
- Previous shoulder dystocia
- Macrosomia >4.5 kg
- DM
- Maternal BMI >30kg/m2
- IOL
ITRAPARTUM
- Prolonged first stage of labour
- Secondary arrest
- Prolonged second stage of labour
- Oxytocin augmentation
- Assissted vaginal delivery
Does IOL prevent shoulder dystocia?
- IOL does not prevent shoulder dystocia in non-diabetic women with a suspected macrosomic fetus.
- IOL at term can reduce the incidence of shoulder dystocia in woman with GDM.
Should elective CS be recommended for suspected fetal macrosomia to prevent BPI?
Elective CS should be considered to reduce the potential morbidity for prenancies complicated by pre-existing or GDM, reardless of treatment, with an estimated fetal weight of >4.5 kg
What is the appropriate mode of delivery for the woman with a previous episode of shoulder dystocia?
Either CS or vaginal delivery can be appropriate after a previous shoulder dystocia. The decision should be made jonitly by the woman and her carers.
Preparation in labour: what measures should be taken when shoulder dystocia is anticipated?
All birth attendant should be aware of the methods for diagnosing shoulder dystocia and the techniques required to facilitate delivery.
How is shoulder dystocia diagnosed?
birth attendants should ruotinely look for the signs of shoulder dystocia.
- difficulty with delivery face & chin
- TURTLE NECK SIGN: head tightly to vulva, even retractin
- failure of resucutation
- failure of shoulder to decend
Routine traction in an axial direction can be used to diagnosed shoulder dystocia but any other traction should be avoided
How should shoulder dystocia be managed?
- Shoulder dystocia should be managed systematically
- Immediately after recognition of shoulder dystocia, additional help should be called.
- The problem should be stated clearly as ‘this is shoulder dystocia’ to the arriving team.
- Fundal pressure should not be used.
- McRoberts’ manoeuvre is a simple, rapid and effective intervention and should be performed first.
- Suprapubic pressure should be used to improve the effectiveness of the McRoberts’ manoeuvre.
- An episiotomy is not always necessary.
What measures should be undertaken if simple techniques fail?
- Internal manoeuvres or ‘all-fours’ position should be used if the McRoberts’ manoeuvre and suprapubic pressure fail.
Persistent failure of first- and second-line manoeuvres: what measures should be taken if first- and second-line manoeuvres fail?
- Third-line manoeuvres should be considered very carefully to avoid unnecessary maternal morbidity
and mortality, particularly by inexperienced practitioners.
What is the optimal management of the woman and baby after shoulder dystocia?
- Birth attendants should be alert to the possibility of postpartum haemorrhage and severe perineal tears.
- The baby should be examined for injury by a neonatal clinician.
- An explanation of the delivery should be given to the parents
What are the recommendations for training?
- All maternity staff should participate in shoulder dystocia training at least annually.
What measures can be taken to ensure optimal MX of shoulder dystocia?
manoeuvres should be demonstrated in direct view, as they are complex and difficult to understand by description alone.
- Hiher fidelity trainn equipment should be used.
documentation
documentation should be accurate and comprehensive
