Week 7 Shoulder dystocia/breach

Question 1

What is shoulder dystocia?

Answer 1

When the head delivers that requires additional obstetric monitors to deliver the shoulders as the anterior shoulder is stick- generally on the pubic symphysis

Question 2

what causes shoulder dystocia?

Answer 2

Difficult to predict- often due to large baby

failure of shoulders to rotate into anterior posteria

Question 3

what are the risk factors for shoulder dystocia?

Answer 3

mother over 35 
maternal weight >90kg
large baby - macrocosmic
high maternal birth weight 
previous shoulder dystocia 
platypoid pelvis

Question 4

what are some of the complications of shoulder dystocia?

Answer 4

increased perineal trauma
post partum hemorrage
psychological trama, post natal depression
trauma/injury to the foetus
if shoulder dystocia last >5mins- there is increased chance of foetal death or brain damage

Question 5

what are some things that would suggest shoulder dystocia?

Answer 5

There is difficulty with the birth of face or chin
the head is born but remains tightly applied to the vulva
the chin retracts to the perinum- turtle sign
the anterior shoulder does not birth down with normal traction- failure to restitute

Question 6

how long can you have to deliver the body of the foetus after the head?

Answer 6

if the rest of the foetus hasn’t delivered with 2 contractions
no more than 5-7 minutes to deliver the baby after delivery of the head

Question 7

what is mcroberts manuvour?

Answer 7

reported success 40-90%
release toxic and flattering sacaral spine to

lie parent on edge of bed and use people to help draw knees to the chest

deliver foetus as normal

Question 8

what is Rubens one?

Answer 8

have third party- partner pushing down on anterior shoulder for 30 seconds
if unsuccessful 3rd party proceeds to roc on anterior shoulder for further 30 seconds

Question 9

what is gaskins manouvour?

Answer 9

roll onto all fours while maintaining mcroberts

facilitates delivory of posterior shoulder

Question 10

what is Rubins 2?

Answer 10

rotating anterior shoulder in a forwards direction

fingers inserted into vagian from the side of the babies back to push the shoulder forward

Question 11

what is wood screw?

Answer 11

where whilst doing Rubens two you add another finger onto the posterior shoulder and try to push that shoulder in the same direction

Question 12

what is reverse woodscrew?

Answer 12

where you push shoulders in the opposite direction

Question 13

what is breach?

Answer 13

this lie os longitudinal but the foetal buttocks lie in the lower segment of the uterus

Question 14

what are the maternal risk factors/causes of breach births?

Answer 14

previous breech birth
muttering malformations - bicornate uterus
prematurity
multipel pregnancies
low lying placentas
oligo/hydraminous fluids
grand multiparty -6 more more babies

Question 15

what are the foetal risk factors for breach birth?

Answer 15

foetal abnormalities
anencephalic
foetal death in utero
decreased foetal activity/impared growth

Question 16

what are the complications of breach births/babies?

Answer 16

cord prolapse
PROM- premature rupture of membranes
higher chance of foetal diability
higher incidence of poor perinatal outocmes
foetal hypoxia
entrapment of the head
head and neck trauma
placental seperation - premature

Question 17

what are the types of breech?

Answer 17

Complete
frank
footling
knee

Question 18

what is complete breach?

Answer 18

the thighs and knees are flexed and the feet close the buttlocks
10% for breach

Question 19

what is frank breech?

Answer 19

legs are flexed at hip with straight knees. the legs lie alongside the trunk and the feet are near the head
45-50% breach lies
common in primigravidae

Question 20

what footling breech?

Answer 20

one or both of the knees/hips are extended and the feet are the presenting part
35% of breach lies
common in preterm

Question 21

what is knee presentation?

Answer 21

one or both hips are extended and the knees are flexed

the knees present below the buttocks

Question 22

how is breech diagnosed?

Answer 22

history 
diagnosis
presenting part
swollen/brusied genitalia
meconium - black toothpaste colour and consistency

Question 23

when should AV never deliver a breech baby?

Answer 23

if there is one foot, one arm or one hand

Question 24

what is an inevitable delivery

Answer 24

inevitable and buttocks or both feet are presenting

Question 25

what is lov sets manouvor?

Answer 25

grasp foetus by the pelvis and pull gently while rotating 90 degrees feel for the anterior shoulder

flex arm down and out

rotate 180 degrees and realise other arm

Question 26

what is done in a breech birth after the delivery of the shoulders?

Answer 26

allow 1-2 minutes
all infant to hand for 1-2 mins
hairline will appear

do not attempt delivery of head

Question 27

what is the omelet manouvour

Answer 27

after nape of neck appears:
lay foetus astride our arm with palm supporting chest
two fingers on the check bones head flexed down

two fingers hook over shoulder and middle fingers pushing the occipital to flex head