Shoulder dystocia

Question 1

At risk of shoulder dystocia

Answer 1

Cephalo-pelvic disproportion
Prev shoulder dystocia
Macorsomia
High BMI
Induction and assisted labour
Long slow labours and second stages

Question 2

Risk for baby with shoulder dystocia

Answer 2

Hypoxia, death
Nerve injury - brachial plexus
Radial and clavicle fracture

Question 3

When do shoulder dystocias suspected

Answer 3

Fail to advance after 2 or 3 pushes

Question 3

When do shoulder dystocias suspected

Answer 3

Fail to advance after 2 or 3 pushes

Question 4

HELPER

Answer 4

HELP
Episiotomy
Legs - mcroberts
Pressure
Enter manouvres
Remove posterior arm
Rollover and repeat

Question 5

What is macroberts manouvre

Answer 5

Lift legs up to head - knees up - tilt coxix to allow pelvis to widen in order to deliver

Question 6

What is macroberts manouvre

Answer 6

Lift legs up to head - knees up - tilt coxix to allow pelvis to widen in order to deliver

Question 7

Pressure how do

Answer 7

Start putting pressure on abdomen like cardiac massage, straight then rocking 30s each
After each manouvre try and deliver

Question 8

Enter manouvres

Answer 8

Push anterior shoulder back
Pull posterior shoulder forward
Do both at same time
Try each for 30s

Question 9

What can do if HELPER doesnt work

Answer 9

Break the clavicle

Question 10

How long to get baby out before pH drops

Answer 10

7 minutes

Question 11

Last line of action

Answer 11

Sympisiotomy - split the pubic symphysis
HEad back in and caesarean section

Question 12

What at risk of after shoulder dystoica?

Answer 12

PPH
PTSD

Question 13

What is assessed in the bishop score?

Answer 13

Foetal station
Cervical position
Cervical dilatation
Cervical effacement
Cervical consistency

Question 14

Scoring for Bishop score

Answer 14

Foetal station (0-3)
Cervical position (0-2)
Cervical dilatation (0-3)
Effacemtent (0-3)
Consistency (0-2)
Maximum score = 13

Question 15

What score predicts successful induction of labour

Answer 15

> 8 on bishop score

Question 15

What score predicts successful induction of labour

Answer 15

> 8 on bishop score

Question 16

What score predicts successful induction of labour

Answer 16

> 8 on bishop score

Question 17

What score predicts successful induction of labour

Answer 17

> 8 on bishop score

Question 18

What does a Bishop score under 8 suggest

Answer 18

Cervical ripening may be required to prepare the cervix

Question 19

What is a membrane sweep?

Answer 19

Insert a finger into cervix to stimulate cervix and begin process of labour

Question 20

When will labour start after a successful membraen sweep?

Answer 20

48 hours

Question 21

What can be inserted into the bagina to induce labour?

Answer 21

Prostagladnin E2 (dinoprostone) - gel, tablet or pessary
Releases prostaglandins over 24 hours

Question 22

What is a cervical ripening balloon?

Answer 22

Silicone balloon inserted into cervix gently inflated to dilate the cervix

Question 23

When is a cervical ripening balloon used over a PGE2?

Answer 23

Women with prev c section Vaginal PGs have failed Multiparous women >3 prec

Question 24

What is used if vaginal PGs cant be used or havent worked

Answer 24

Artificial rupture of membranes with an oxytocin infusion

Question 25

What is used to induce labour if intrauterine foetal death has occured?

Answer 25

Oral mifeprisotne (anti-progesterone) + misoprostol

Question 26

What is used for monitoring the induction of labour>

Answer 26

Cardiotocography (CTG) - assess foetal HR and uterine contractions before and during induciton of labour Bishops score - progress

Question 27

Options when slow or no progress in labour

Answer 27

* Further vaginal prostaglandins * Artificial rupture of membranes and oxytocin infusion * Cervical ripening balloon (CRB) * Elective caesarean section

Question 28

When should most women give birth within after labour starts

Answer 28

24 hours

Question 29

What is the main complication of vaginal PGs

Answer 29

Uterine hyperstimulation

Question 30

What happens in uterine hyperstimulation

Answer 30

Contraction of uteris is prolonged and frequent -> foetal distress and compromise

Question 30

What happens in uterine hyperstimulation

Answer 30

Contraction of uteris is prolonged and frequent -> foetal distress and compromise

Question 31

What is the criteria for uterine hyperstimulation

Answer 31

individual uterine contractions lasting more than 2 mins >5 uterine contractions every 10 mins

Question 32

What can uterine hyperstimulation lead to?

Answer 32

Foetal compromuse w hypoxia and acidosis Emergency C section Uterine rupture

Question 33

Managemnet of uterine hyperstimulation

Answer 33

Remocing vaginal OGs or stopping oxytocin infusion Tocolysis (preventing birth) with terbutaline

Question 34

What is failure of restitution

Answer 34

Head remains face down - occipito anterior - and does not turn sidewyas as expected after delivery

Question 35

Turtle-neck sign

Answer 35

Head delivered, then retracts back into vagina

Question 36

Steps to managing shoulder dystoica

Answer 36

Shout for help incl anaesthetics and paeds Episiotomy McRoberts Pressure to anterior shoulder Rubins manouvre Woods screw manouvre Zavanelli manouvre

Question 37

Complications of shoulder dystocia

Answer 37

* Fetal hypoxia (and subsequent cerebral palsy) * Brachial plexus injury and Erb’s palsy * Perineal tears * Postpartum haemorrhage

Question 38

Zavanelli manouvre what is

Answer 38

involves pushing the baby’s head back into the vagina so that the baby can be delivered by emergency caesarean section.

Question 39

Wood screw manouvre

Answer 39

performed during a Rubins manoeuvre. The other hand is used to reach in the vagina and put pressure on the anterior aspect of the posterior shoulder. The top shoulder is pushed forwards, and the bottom shoulder is pushed backwards, rotating the baby and helping delivery. If this does not work, the reverse motion can be tried, pushing the top shoulder backwards and the bottom shoulder forwards.

Question 40

What is rubins manouvre

Answer 40

involves reaching into the vagina to put pressure on the posterior aspect of the baby’s anterior shoulder to help it move under the pubic symphysis.

Question 41

What is Mcroberts manouvre

Answer 41

involves hyperflexion of the mother at the hip (bringing her knees to her abdomen). This provides a posterior pelvic tilt, lifting the pubic symphysis up and out of the way.

Question 42

Pressure to anterior shoulder