Shoulder Dystocia Flashcards
Define Shoulder Dystocia
RCOG (2012) defines this as a situation where the anterior should (or less commonly the posterior shoulder) impacts on the maternal symphysis pubis or the sacral promontory.
Incidence rate of Shoulder Dystocia
0.5-0.7% (RCOG)
Risk factors of Shoulder Dystocia
- High BMI
- Diabetic Mother
- Previous SD
- Macrosomic baby
- IOL
- Prolonged 1st/ 2nd stage
- Assisted delivery
Risk of hypoxia –> explain stages
- Inital stage of hypoxia, baby will attempt to breathe.
- continued hypoxia baby loses consciousness.
- Lack of oxygen to neural centres. Primary apnoea, no respiratory effort.
- HR decreases. Reduced perfusion of vital organs.
- Release of lactic acid in the anaerobic respiration
- Agonal gasps may occur
- Gasps fade, terminal apnoea.
- Acidosis worsens leading to HIE and impaired cardiac functioning.
- Hypoxia continues HR falls, and this can lead to death (20 minutes for healthy term baby)
Signs of SD
- Difficult delivery of face or chin
- Head tight to vulva
- An appearance of fat cheeks
- Turtle necking
- Lack of restitution
- No delivery of shoulders with axial traction
Complications of SD
- Increased risk of PPH
- Maternal trauma
- Brachial Plexus injury
- Hypoxic injury to baby (HIE) due to cord compression
How many minutes to resolve SD from delivery of head?
7 minutes
Initial record?
- Time of head
- Time of SD
Aim of the maneuvers in SD?
Reduce Biacromial diameter
HELPERR
Help Evaluate for epis? Legs in McRoberts Pressure (SPP) Enter for internal maneuvers Removal of the posterior arm Roll (onto all fours) AXIAL TRACTION
How long per maneuver?
no more than 30 seconds
Further obstetric interventions?
Cleidotomy- Break clavicle (reduce biacromial diameter)
Zavanelli- Push the baby back up for section
Hysterotomy- Rotation through uterine incision
Symphysiotomy - Division of the symphysis pubis
Risk of PPH
Increased by 11%. Active 3rd stage & monitor blood loss
