SHOULDER DYSTOCIA & UTERINE RUPTURE Flashcards
What is shoulder dystocia?
SD is defined as a delivery that requires additional obstetric maneuvers to release the shoulders after gentle downward traction has failed. It occurs when the anterior or posterior fetal shoulder impacts on the maternal pubic symphysis or sacral promontory.
What is the incidence rate of shoulder dystocia?
0.6 -1.4%
What is the recurrence rate of shoulder dystocia?
13 � 25%
What are the risk factors for shoulder dystocia?
Maternal: Diabetes, short stature, previous shoulder dystocia, obesity.
Fetal: Macrosomia, post-maturity.
Intrapartum: Long 1st stage of labor, prolonged 2nd stage, instrumental delivery, induction of labor, use of oxytocin.
How is shoulder dystocia diagnosed?
Signs include facial flushing and the ‘turtle sign’.
What are the maternal complications of shoulder dystocia?
Genital tract injuries (3rd & 4th-degree perineal laceration, vaginal and cervical lacerations, uterine rupture), postpartum hemorrhage, bladder atony.
What are the fetal complications of shoulder dystocia?
Brachial plexus injury (Erb-Duchenne and Klumpke palsies), fractures (clavicle, humerus), perinatal asphyxia, perinatal death, clavicle/sternomastoid hematoma, hypoxic brain injury.
What does the HELPERRR mnemonic stand for in managing shoulder dystocia?
H: Call for help,
E: Evaluate episiotomy,
L: Legs (McRoberts� maneuver),
P: Suprapubic pressure (Rubin I maneuver),
E: Enter maneuvers (internal rotation),
R: Remove the posterior arm,
R: Roll the patient (all-fours position),
R: Rescue maneuvers.
How does the McRoberts maneuver work?
McRoberts maneuver straightens the sacrum, lifts the pubic bone over the baby’s shoulder, and shifts the back shoulder into the sacral hollow, widening the pelvis and aiding delivery.
How does suprapubic pressure work?
Used with McRoberts’ maneuver to improve success by reducing shoulder width and rotating the front shoulder into an oblique position, helping it slip under the pubic bone.
How does the Rubin II maneuver work?
Inserting two fingers into the vagina to apply pressure on the back of the baby’s front shoulder, pushing it toward the chest to rotate the shoulder into an oblique position.
How does the Woods corkscrew maneuver work?
If Rubin II fails, applying gentle upward pressure on the back shoulder while maintaining pressure on the front shoulder, aiding in rotation for delivery.
How does the removal of the posterior arm (Jacquemier maneuver) work?
Delivery of the posterior arm reduces the baby’s shoulder width, allowing the baby to drop into the sacral hollow and free the stuck front shoulder.
How does the Gaskin maneuver work?
The mother moves into an all-fours position, using gravity to create more space in the sacral hollow, allowing for easier delivery of the back shoulder and arm.
What are the last-resort (rescue) maneuvers for shoulder dystocia?
Deliberate clavicular fracture (not cleidotomy), Zavanelli maneuver, symphysiotomy, hysterotomy.
How does the Zavanelli maneuver work?
Involves pushing the baby’s head back into the uterus, followed by an emergency C-section. Used in severe, bilateral shoulder dystocia when other maneuvers fail.
How can shoulder dystocia be prevented?
Induction of labor at term in women with gestational diabetes. Elective C-section for estimated fetal weight =4.5kg in diabetes-complicated pregnancies.
What is uterine rupture?
Full-thickness separation of uterine muscle requiring immediate surgical intervention.
What are the classifications of uterine rupture?
Scar dehiscence (incomplete separation, asymptomatic) and complete uterine rupture (full-thickness tear, symptomatic, life-threatening emergency).
What are the epidemiology statistics of uterine rupture?
Unscarred uterus: 6.1 per 10,000 deliveries. Previous C-section (VBAC attempt): 22-74 per 10,000 deliveries.
What are the risk factors for uterine rupture?
Previous C-section (87% of cases), uterine scar type, short inter-delivery interval, uterine surgery, uterine anomalies, blunt trauma, obstructed labor, cephalopelvic disproportion, fetal malposition, excessive oxytocic use, placenta percreta, polyhydramnios, macrosomia, multiple pregnancy.
What are the clinical features of uterine rupture?
Sudden tearing abdominal pain, abnormal vaginal bleeding, cessation of uterine contractions, regression of the fetal presenting part, maternal tachycardia/hypotension, easily palpable fetal parts outside the uterus.
What are the general management principles of uterine rupture?
Maternal resuscitation (ABCD), stop oxytocin, administer oxygen, left lateral position with tilt, urgent blood cross-match, second large bore cannula, call anesthetist and theater team, anticipate neonatal emergency.
What are the specific treatment options for uterine rupture?
Laparotomy with uterine repair � bilateral tubal ligation (BTL) if feasible, or hysterectomy if repair is difficult or hemorrhage persists.
