shoulder_dystocia_flashcards
What is shoulder dystocia?
Shoulder dystocia is an emergency where the baby’s shoulder becomes stuck after the head is delivered.
What is the first step in managing shoulder dystocia?
Lie woman flat and tell her to STOP pushing.
Who should be called for help during shoulder dystocia?
Senior, anaesthetist, and neonatal help (press the emergency buzzer or 2222).
What is the purpose of external manoeuvres in shoulder dystocia?
To increase the relative anterior-posterior diameter of the pelvis.
What is the McRobert’s manoeuvre?
Place patient with hips hyper-flexed and abducted (‘thighs to abdomen’), successful in 90% of cases.
What is the McRobert’s manoeuvre with suprapubic pressure?
Apply pressure down and forward to decrease the shoulder diameter, used to improve McRobert’s.
When should episiotomy be considered in shoulder dystocia?
If it will make internal manoeuvres easier.
What is the purpose of internal manoeuvres in shoulder dystocia?
To reduce the shoulder diameter by abducting the shoulder and allowing rotation into the wider oblique pelvis diameter.
What is the Rubin II manoeuvre?
Insert a hand behind the anterior shoulder and push it towards baby’s chest.
What is the Wood’s screw manoeuvre?
Rubin II manoeuvre + insert second hand to apply pressure to front of posterior shoulder to aid further rotation.
How can the posterior arm be delivered in shoulder dystocia?
Grasp the baby’s wrist, and gently tug the posterior arm from the vagina in a straight line. Risk of humeral fractures.
What can be done if initial manoeuvres are unsuccessful in shoulder dystocia?
Change position to all fours or repeat all of the above manoeuvres.
What are the third-line manoeuvres in shoulder dystocia?
Foetal cleidotomy, maternal symphisiotomy, or Zavanelli (vaginal replacement of the foetal head followed by a CS).
What should be done post-delivery in cases of shoulder dystocia?
Baby should be reviewed by neonatologist and a clinical incident reporting form must be completed.
What are the complications of shoulder dystocia in the baby?
Brachial plexus injury (BPI), humerus/clavicle fractures, pneumothorax, hypoxic brain damage.
