Shoulder Dystocia

Question 1

WHAT IS SHOULDER DYSTOCIA ?

Answer 1

DURING THE DELIVERY OF THE BABY THE ANTERIOR SHOULDER IMPACTS ON THE SYMPHYSIS PUBIS.

Question 2

HOW MANY BIRTHS DOES SHOULDER DYSTOCIA AFFECT?

Answer 2

1%

Question 3

WHAT IS THE PROBLEM ? SHOULDER DYSTOCIA

Answer 3

BABIES SHOULDERS ARE TOO BIG FOR THE NARROW PELVIC OPENING

Question 4

RISK FACTORS OF SHOULDER DYSTOCIA?

Answer 4

PREVIOUS SHOULDER DYSTOCIA
DIABETES MELLITUS
FETAL MACROSOMIA
MATERNAL OBESITY

PROLONGED FIRST STAGE
PROLONGED SECOND STAGE
AUGMENTATION OF LABOUR
INSTRUMENTAL DELIVERY

Question 5

DOES IT JUST HAVE TO BE WOMEN WITH RISK FACTORS?

Answer 5

NO

Question 6

ARE WOMEN WITH RISK FACTORS MORE LIKELY TO GET SHOULDER DYSTOCIA?

Answer 6

NO IN FACT WOMEAN WITH NO RISK FACTORS OCCUPY THE MAJORITY OF THE CASES.

Question 7

WHAT DO CLINICIANS NEED TO BE AWARE OF WITH SHOULDER DYSTOCIA?

Answer 7

RISK FACTORS

Question 8

DO CLINICIANS NEED TO BE ALERT FOR THE POSSIBILITY OF SHOULDER DYSTOCIA?

Answer 8

YES

Question 9

SIGNS OF A SHOULDER DYSTOCIA?

Answer 9

DIFFICULT DELIVERY OF FACE AND CHIN
HEAD REMAINS TIGHTLY APPLIED TO THE VULVA
CHIN RETRACTION (TURTLE NECKING)
ANTERIOR SHOULDER FAILS TO DELIVER WITH ROUTINE AXIAL TRACTION
DONT PULL DOWN ON BABY’S HEAD.

Question 10

WHAT SHOULD I KEEP IN LINE WHEN ANTERIOR SHOULDER FAILS TO DELIVER WITH ROUTINE AXIAL TRACTION ?

Answer 10

THE BABYS HEAD NEEDS TO BE KEPT IN LINE WITH THE SPINE

Question 11

MANAGING SHOULDER DYSTOCIA

Answer 11

CALL FOR HELP
DISCOURAGE PUSHING
LIE THE WOMAN FLAT / MOVE TO THE EDGE OF THE BED/SOFA
McROBERTS POSITION
SUPRAPUBIC PRESSURE
ROTATE ONTO ALL FOURS

MIDWIVES CAN DO INTERNAL MANEUVERS PARAMEDICS CANNOT BUT THEY CAN ASSIST

Question 12

WHAT DOES THE MCROBERTS POSITION DO?

Answer 12

TILTS THE PELVIS IN AN ATTEMPT TO MAKE THE OPENING WIDER/

Question 13

HOW IS MCROBERTS DONE

Answer 13

LIE PT FLAT
STRAIGHTEN THE LEGS
HYPERFLEX HIPS SO KNEES ARE NEXT TO THE EARS
APPLY ROUTINE AXIAL TRACTION ON THE FETAL HEAD

Question 14

WHAT IS ROUTINE AXIAL TRACTION?

Answer 14

Applying the same amount of pulling force as used during a typical childbirth in a straight line.

Question 15

WHAT DIRECTION IS AXIAL TRACTION PERFORMED?

Answer 15

IN LINE WITH THE AXIS OF THE FETAL SPINE

Question 16

WHEN IS ROUTINE AXIAL TRACTION PERFORMED?

Answer 16

TO SEE IF EACH MANEUVER HAS BEEN SUCCESSFUL

Question 17

WHAT DOES SUPRAPUBIC PRESSURE AIM TO DO?

Answer 17

The goal is to decrease the width of the baby’s shoulders and pivot the front shoulder into the broader diagonal angle of the pelvis.

Question 18

HOW IS SUPRAPUBIC PRESSURE DONE?

Answer 18

APPLY FIRM PRESSURE FROM SIDE OF THE FETAL BACK IN A DOWNWARD LATERAL DIRECTION - ROCK CONTINUOUSLY.

Question 19

DO YOU APPLY AXIAL TRACTION TO THE FETAL HEAD AFTER SUPRAPUBIC PRESSURE ?

Answer 19

YES YOU SHOULD APPLY ROUTINE AXIAL TRACTION