Shoulder dystocia Flashcards Preview

Obstetrics and Gynaecology > Shoulder dystocia > Flashcards

Flashcards in Shoulder dystocia Deck (13):
1

Definition

Failure to deliver the shoulders following the head

2

Signs (3)

Chin pulling back onto perineum No external signs of restitution Anterior shoulder fails to deliver following contraction

3

Predisposing factors (7)

Previous shoulder dystocia >4.5kg baby Maternal diabetes, obesity Prolonged first stage Prolonged second stage with augmentation Instrumental vaginal delivery

4

Maternal risks

Trauma vaginal, bladder, bowel, episiotomy Psychological

5

Neonatal risks

Erbs palsy Cerebral palsy from hypoxia Fractures Death

6

Management

Help- get as many as you can: pediatrics, obstetrics, surgeons, anaesthetics Episiotomy if require more room Legs- perform McRoberts Pressure- suprapubic pressure, downward and lateral to push shoulder under pelvic symphysis Enter manouvres Remove the posterior arm by lifting the head anteriorly Roll the woman on all fours

7

Describe McRoberts manouevre

Abduction and acute flexion of the hips Straightens pelvis, maximises diameter, flex fetal spine Apply gentle suprapubic pressure

8

Describe the Rubin 2 manouvre

Approach anterior shoulder from behinf Pressure on scapula to adduct ant shoulder rotate to oblique

9

Reverse woods screw

Approach posterior shoulder from behind Rotate

10

Woods screw

Approach posterior shoulder from anterior Gentle rotation toward symphysis

11

Last resorts for shoulder dystochia

Zavanelli manouevre Clavicle fracture Symphysiotomy

12

What examination must you not forget with episiotomy/repair

Rectal examination-->identify any trauma to rectal mucosa

13

Time to deliver for shoulder dystocia before terrible outcome very likely

7 minutes