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Obstetric And Gynecology > Shoulder dystocia & Uterine rupture > Flashcards

Shoulder dystocia & Uterine rupture Flashcards

1
Q

Define Shoulder Dystocia (SD) in clinical terms.

A

Delivery requiring additional obstetric maneuvers after failure of gentle downward traction.

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2
Q

What is the incidence rate of SD?

A

0.6–1.4%.

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3
Q

List three antepartum risk factors for SD.

A

Macrosomia, diabetes, maternal obesity.

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4
Q

Identify two intrapartum risk factors associated with SD.

A

Prolonged second-stage labor, assisted vaginal delivery.

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5
Q

What is the “turtle sign,” and how does it relate to SD?

A

Appearance and retraction of the fetal head indicating impacted shoulders.

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6
Q

Name two maternal complications of SD.

A

Uterine rupture, postpartum hemorrhage.

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7
Q

Mention two fetal complications of SD.

A

Brachial plexus injury, fractures of clavicle or humerus.

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8
Q

What is the HELPERRR mnemonic, and what does each letter stand for?

A

Help, Episiotomy, Legs (McRoberts), Pressure (suprapubic), Enter (internal maneuvers), Remove posterior arm, Roll patient, Rescue maneuvers.

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9
Q

Explain the McRoberts’ maneuver.

A

Hyperflex maternal thighs to abdomen; increases uterine contractions.

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10
Q

Describe the Woods’ corkscrew maneuver.

A

Rotate the posterior shoulder into an oblique pelvic diameter.

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11
Q

What is the purpose of the Zavanelli maneuver?

A

Cephalic replacement followed by Cesarean section.

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12
Q

What is the clinical definition of uterine rupture?

A

Full-thickness uterine muscle separation.

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13
Q

Identify two risk factors for uterine rupture.

A

Previous C-section, blunt trauma.

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14
Q

Describe two clinical features of uterine rupture.

A

Sudden uterine pain, fetal parts outside uterus.

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15
Q

List three general steps in the management of uterine rupture.

A

Maternal resuscitation, group and cross-match blood, emergency laparotomy.

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16
Q

Why is maternal resuscitation critical in managing uterine rupture?

A

Prevents maternal shock and ensures blood supply.

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17
Q

What is the role of episiotomy in managing SD?

A

Facilitates internal maneuvers; does not directly relieve SD.

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18
Q

How does suprapubic pressure aid in relieving SD?

A

Reduces bisacromial diameter, rotates shoulder.

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19
Q

Define Rubin II maneuver and its function.

A

Digital pressure to posterior shoulder, rotating it into oblique diameter.

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20
Q

How is the Gaskin maneuver performed, and what is its goal?

A

Patient on “all-fours”; facilitates delivery via gravity.

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21
Q

State the recurrence risk percentage of SD.

A

13–25%.

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22
Q

Differentiate between complete and occult uterine rupture.

A

Complete: full separation; Occult: partial separation.

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23
Q

Why are rotational forceps associated with uterine rupture?

A

Increase risk of uterine tears during manipulation.

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24
Q

Discuss one prevention strategy for SD.

A

Elective Cesarean for high-risk cases.

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25
Q

Explain the potential risks of VBAC for uterine rupture.

A

Risk increases with classical vertical incisions.

26
Q

How does maternal obesity contribute to SD risk?

A

Alters pelvic dynamics, increasing impact risk.

27
Q

Fill in the blank: “SD is most often an __________ and __________ obstetric emergency.”

A

Unpredictable, unpreventable.

28
Q

Fill in the blank: “The __________ maneuver straightens the sacrum relative to the lumbar spine.”

A

McRoberts.

29
Q

True or False: Episiotomy alone resolves SD.

A

False.

30
Q

Multiple-choice: Which maneuver involves rotating the posterior shoulder into the oblique pelvic diameter? a) McRoberts, b) Rubin II, c) Woods’ corkscrew

A

b) Rubin II.

31
Q

Why is timely recognition critical in managing SD?

A

Prevents complications like brachial plexus injury.

32
Q

Name two complications associated with excessive traction on the fetal head during SD.

A

Brachial plexus injury, clavicular fracture.

33
Q

How does the maternal short stature affect SD risk?

A

Reduces pelvic capacity.

34
Q

Fill in the blank: “Fetal __________ injury is a common complication of SD.”

A

Plexus.

35
Q

Explain the significance of “all-fours” in the Gaskin maneuver.

A

Creates more pelvic space for shoulder maneuvering.

36
Q

Identify one uterine anomaly contributing to uterine rupture.

A

Undeveloped uterine horn.

37
Q

True or False: The Zavanelli maneuver involves vaginal delivery.

A

False.

38
Q

Multiple-choice: What is the main objective of hysterotomy in uterine rupture? a) Avoid Cesarean section, b) Rotational delivery, c) Repair uterine muscle

A

c) Repair uterine muscle.

39
Q

What is the primary goal of internal rotation maneuvers in SD?

A

Free impacted fetal shoulders.

40
Q

Why is the term “obstetric catastrophe” used to describe uterine rupture?

A

Reflects its life-threatening potential.

41
Q

Fill in the blank: “Prolonged __________ labor is an intrapartum risk factor for SD.”

A

Second-stage.

42
Q

Name one fetal condition contributing to uterine rupture risk.

A

Hydrocephalus.

43
Q

Fill in the blank: “Maternal age above __________ years is an antepartum risk for SD.”

A

35

44
Q

True or False: Fundal pressure is recommended for managing SD.

A

False.

45
Q

How does polyhydramnios increase the risk of uterine rupture?

A

Overstretching uterine walls.

46
Q

Describe the Rubin I maneuver.

A

Downward, lateral suprapubic pressure to rotate shoulder.

47
Q

What does the term “bisacromial diameter” refer to in SD?

A

Width of fetal shoulders.

48
Q

Why is the sacral promontory relevant in SD?

A

Site of shoulder impaction.

49
Q

List one reason episiotomy may be performed during SD.

A

Facilitate internal maneuvers.

50
Q

Fill in the blank: “Brachial __________ injuries are a possible fetal complication of SD.”

A

Plexus.

51
Q

What is the role of an obstetrician in managing uterine rupture?

A

Perform surgery and manage complications.

52
Q

Explain why induction of labor might prevent SD.

A

Prevents macrosomia-related complications.

53
Q

Describe a scenario where hysterotomy may be preferred over other interventions.

A

Extensive rupture with hemorrhage.

54
Q

Fill in the blank: “Secondary arrest of labor is a(n) __________ risk factor for SD.”

A

Intrapartum.

55
Q

True or False: Shoulder dystocia is always preventable.

A

False.

56
Q

How does diabetes increase SD risk?

A

Increases fetal macrosomia risk.

57
Q

What type of incision carries the highest risk of uterine rupture?

A

Classical vertical incision.

58
Q

Name one neonatal complication of uterine rupture.

A

Hypoxia.

59
Q

Describe how the Jacquimier maneuver helps in SD management.

A

Reduces bisacromial diameter by removing posterior arm.

60
Q

Fill in the blank: “__________ delivery is sometimes necessary after the Zavanelli maneuver.”

A

Cesarean.

Obstetric And Gynecology (12 decks)

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