Week 7 Shoulder dystocia/breach Flashcards
What is shoulder dystocia?
When the head delivers that requires additional obstetric monitors to deliver the shoulders as the anterior shoulder is stick- generally on the pubic symphysis
what causes shoulder dystocia?
Difficult to predict- often due to large baby
failure of shoulders to rotate into anterior posteria
what are the risk factors for shoulder dystocia?
mother over 35 maternal weight >90kg large baby - macrocosmic high maternal birth weight previous shoulder dystocia platypoid pelvis
what are some of the complications of shoulder dystocia?
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
what are some things that would suggest shoulder dystocia?
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
how long can you have to deliver the body of the foetus after the head?
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
what is mcroberts manuvour?
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
what is Rubens one?
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
what is gaskins manouvour?
roll onto all fours while maintaining mcroberts
facilitates delivory of posterior shoulder
what is Rubins 2?
rotating anterior shoulder in a forwards direction
fingers inserted into vagian from the side of the babies back to push the shoulder forward
what is wood screw?
where whilst doing Rubens two you add another finger onto the posterior shoulder and try to push that shoulder in the same direction
what is reverse woodscrew?
where you push shoulders in the opposite direction
what is breach?
this lie os longitudinal but the foetal buttocks lie in the lower segment of the uterus
what are the maternal risk factors/causes of breach births?
previous breech birth muttering malformations - bicornate uterus prematurity multipel pregnancies low lying placentas oligo/hydraminous fluids grand multiparty -6 more more babies
what are the foetal risk factors for breach birth?
foetal abnormalities
anencephalic
foetal death in utero
decreased foetal activity/impared growth
what are the complications of breach births/babies?
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
what are the types of breech?
Complete
frank
footling
knee
what is complete breach?
the thighs and knees are flexed and the feet close the buttlocks
10% for breach
what is frank breech?
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
what footling breech?
one or both of the knees/hips are extended and the feet are the presenting part
35% of breach lies
common in preterm
what is knee presentation?
one or both hips are extended and the knees are flexed
the knees present below the buttocks
how is breech diagnosed?
history diagnosis presenting part swollen/brusied genitalia meconium - black toothpaste colour and consistency
when should AV never deliver a breech baby?
if there is one foot, one arm or one hand
what is an inevitable delivery
inevitable and buttocks or both feet are presenting
what is lov sets manouvor?
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
what is done in a breech birth after the delivery of the shoulders?
allow 1-2 minutes
all infant to hand for 1-2 mins
hairline will appear
do not attempt delivery of head
what is the omelet manouvour
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
