Shoulder Dystocia Flashcards
What is the definition of a shoulder dystocia?
A vaginal cephalic delivery that requires additional obstetric manoeuvres to deliver the foetus after the head has delivered and gentle traction has failed
When should the body ideally be delivered?
1-2 minutes after the head
What is one signs of macrosomia?
Slow progress in labour
What are some antenatal risk factors for shoulder dystocia?
- BMI >30
- > 35 years old
- Diabetes
- Multigravida
- Previous SD
- Previous big baby
- Post-maturity
- History of pelvic injury
What are some intrapartum risk factors for shoulder dystocia?
- Slow progress in 1st stage
- Arrest of progress at 8cm
- Prolonged 2nd stage requiring augmentation
- Instrumental delivery
- Slow delivery of face/ chin
- Turtle necking
What are some of the complications of shoulder dystocia?
- PPH
- Trauma
- Ruptured uterus
- Brachial plexus injury
- Fractured clavicle
- Humeral fracture
What is the brachial plexus?
- Network of nerves
- Conducts signals from the spine to the shoulder, arm and hand
What are some symptoms of a brachial plexus injury?
- Limp/ paralysed arm
- Lack of muscle control in arm, hand or wrist
- Lack of feeling/ sensation in arm/hand
Describe foetal pH during delivery
- Drops by 0.04 per minute
- Within 7 minutes, the pH will have decreased by 0.28, the baby must be out by this time
What is some of the basic management for shoulder dystocia?
- Anticipate
- If risk factors are present, inform coordinator and senior medical staff
- Make mother aware
- Do not cut the cord if around neck
- Documentation
What are the 3 P’s that should be avoided?
- Pull excessively
- Push on fundus
- Pivot foetal head
What is the procedure for shoulder dystocia?
- Call for help
- Discourage pushing, lie bed flat, buttocks to edge of bed
- McRoberts
- Suprapubic pressure
- Deliver posterior arm
- Internal rotation
- Repeat each step again
- Consider additional management
What is the McRoberts position?
Thighs to abdomen and apply gentle traction
What is suprapubic pressure?
- Apply on side of foetal back
- Reduces shoulder diameter by adducting shoulders
- Rotates anterior shoulder into oblique pelvic diameter
- Continuous or rocking
How should the midwife enter her hand for manoeuvres?
Posteriorly via the sacral hollow
How does the midwife perform manoeuvres?
- Push anterior aspect of posterior shoulder and posterior aspect of anterior shoulder
- Rotate into oblique diameter
- Stop suprapubic pressure
How is the posterior arm delivered?
- Grasp the wrist and gently withdraw in a straight line
- High risk of humeral fracture
What needs to be recorded?
- Time of delivery of head
- Time of delivery of body
- Direction of head and foetal back
- Manoeuvres performed with times
- Staff present
- Condition of baby on delivery
- Cord gases
What are the 3 D’s relating to post-delivery care?
- Debrief
- Datix
- Documentation
What are the 3 types of additional management?
- Zavanelli Manoeuvre (push head back up and perform CS)
- Symphysiotomy (symphysis pubis divided to widen pelvis)
- Cleidotomy (surgical division of clavicle)
