Shoulder dystocia and cord prolapse Flashcards
when should one be suspicious of shoulder dystocia
- Turtle sign is present or seen
- When the head is delivered but there are difficulties in delivering the anterior shoulder
- when the fatal head is delivered but remains tightly applied to the vulva
- when the head fails to deliver with normal manoeuvres
- when the chin retracts and depresses the perineum.
name three dangers associated with shoulder dystocia
- entrapment of umbilical cord.
- inability of Childs chest to expand properly.
- severe brain damage or death if child is not delivered in minutes.
what are some of the first things to do when you encounter shoulder dystocia
- call for help
- place patient on the edge of the bed.
- communicate what is happening with the patient and let her know that this is an emergency and her co-operation is needed.
what is the name of the manoeuvre used to assist in the event of shoulder dystocia.
McRobert’s Manoeuvre.
explain the McRobert’s Manoeuvre
Hyper flex the hips and support knees as far as possible to the chest and abduct and rotate legs outwards to help maxine the AP diameter available.
this allows the pelvis to tilt, orientating the symphysis more horizontally to facilitate shoulder delivery.
anterior shoulder delivery
- after increasing AP diameter, apply supra pubic pressure using heel of the hand. –> this should be done directly above patient from the sides.
- when delivering the anterior should you can consider an episiotomy to help reduce soft tissue obstruction and make more room for other manoeuvres.
posterior shoulder
to deliver the posterior shoulder first try to deliver the posterior arm.
- sweep the arm across the chest - this will provide room for the anterior shoulder to move under the symphysis.
salvage
delivering the posterior shoulder by threading a catheter between the shoulder and posterior arm and using this to exert traction.
- then turn the patient on all fours position, this will often dislodge the shoulder.
shoulder dystocia delivery mnemonic
HEMAPS
H - call for help
E- put the patient on the edge of the bed
M - McRoberts
A - Anterior shoulder
P - posterior shoulder
S - salvage (all fours, catheter through)
what is cord prolapse
The umbilical cord is felt in the vaginal canal following rupture of membranes or is felt in on vaginal examination to be coming down below the presenting part.
what is cord presentation
the presenting part is the cord with membranes intact. the diagnosis is felt by feeling the cord pulsating.
delivery is by C/S
What are the factors to look for in cord prolapse.
- look at or gently feel the cord to check for any pulsations and if there are pulsations then the fetus is alive.
- determine the lie and presenting part; the baby may be in traverse and the mother may need a C/S
- do a Vaginal Exam to determine the status of labour.
what do you do in cord prolapse when the cord is pulsating and mother is in first stage of labour?
- need to stop the presenting part from compressing the head.
- insert IV line and refer for C/S
- give tocolysis (salbutamol 0.2 mg IV slowly over 2 minutes)
how to you stop the presenting part From compressing the cord
- manually displace the presenting part
- replace the cord in the vagina
- DO NOT wrap the cord in warm towel
fill the empty bladder (400ml) and CLAMP THE CATHETER - establish a knee below elbow position or left lateral
what do you do when the cord is pulsating and second stage of labour
- delivery should happen, make use of episiotomy and vacuum extraction or forceps delivery.
- if the baby is breech, perform a breech delivery,
- prepare to resuscitate the newborn.
