shoulder_dystocia_flashcards

1
Q

What is shoulder dystocia?

A

Shoulder dystocia is an emergency where the baby’s shoulder becomes stuck after the head is delivered.

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2
Q

What is the first step in managing shoulder dystocia?

A

Lie woman flat and tell her to STOP pushing.

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3
Q

Who should be called for help during shoulder dystocia?

A

Senior, anaesthetist, and neonatal help (press the emergency buzzer or 2222).

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4
Q

What is the purpose of external manoeuvres in shoulder dystocia?

A

To increase the relative anterior-posterior diameter of the pelvis.

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5
Q

What is the McRobert’s manoeuvre?

A

Place patient with hips hyper-flexed and abducted (‘thighs to abdomen’), successful in 90% of cases.

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6
Q

What is the McRobert’s manoeuvre with suprapubic pressure?

A

Apply pressure down and forward to decrease the shoulder diameter, used to improve McRobert’s.

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7
Q

When should episiotomy be considered in shoulder dystocia?

A

If it will make internal manoeuvres easier.

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8
Q

What is the purpose of internal manoeuvres in shoulder dystocia?

A

To reduce the shoulder diameter by abducting the shoulder and allowing rotation into the wider oblique pelvis diameter.

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9
Q

What is the Rubin II manoeuvre?

A

Insert a hand behind the anterior shoulder and push it towards baby’s chest.

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10
Q

What is the Wood’s screw manoeuvre?

A

Rubin II manoeuvre + insert second hand to apply pressure to front of posterior shoulder to aid further rotation.

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11
Q

How can the posterior arm be delivered in shoulder dystocia?

A

Grasp the baby’s wrist, and gently tug the posterior arm from the vagina in a straight line. Risk of humeral fractures.

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12
Q

What can be done if initial manoeuvres are unsuccessful in shoulder dystocia?

A

Change position to all fours or repeat all of the above manoeuvres.

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13
Q

What are the third-line manoeuvres in shoulder dystocia?

A

Foetal cleidotomy, maternal symphisiotomy, or Zavanelli (vaginal replacement of the foetal head followed by a CS).

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14
Q

What should be done post-delivery in cases of shoulder dystocia?

A

Baby should be reviewed by neonatologist and a clinical incident reporting form must be completed.

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15
Q

What are the complications of shoulder dystocia in the baby?

A

Brachial plexus injury (BPI), humerus/clavicle fractures, pneumothorax, hypoxic brain damage.

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16
Q

What are the complications of shoulder dystocia in the mother?

A

PPH, 3rd/4th degree tears, uterine rupture, cervical tears, sacroiliac joint dislocation, bladder rupture, vaginal lacerations.