Shoulder dystocia (Complete) Flashcards
(18 cards)
Define shoulder dystocia
Type of obstructed labour caused when anterior shoulder is impacted behing maternal pubic symphysis
What are the main risk factors for shoulder dystocia?
Maternal short stature/small pelvis
Maternal obesity
Maternal diabetes (macrosomia)
Advanced maternal age
Macrosomia
Post-date pregnancy
What are the clinical features of shoulder dystocia?
Difficult delivery of face and chin
Foteal head retraction (turtle-neck sign)
Difficulty delivering anterior shoulder
What is the management plan for shoulder dystocia?
1) Call for help (senior obstetrician,paediatrician and anaesthesetist)
2) Stop fundal pressure (minimise uterine rupture) + tell mother to stop pushing
3) McRoberts maneuvre
- Hyperflexion and abduction of hip +/- applied suprapubic pressure
4) All fours –> internal maneuvres –> cleidotomy or symphysiotomy –> zavanelli maneuvre
Following management:
Maternal monitoring:
Check for:
- PPH
- Perineal tears
- Genital tract injiry
Neonate monitoring:
Check for:
- Brachial plexus injury
- Hypoxia
- Clavicular and humeral fractures
What is McRobert’s maneuvre?
Hyperflexion and abduction of hip to abdomen +/- applied suprapubic pressure
Increases the relative anterior-posterior angle of the pelvis to facilitate easier delivery
McRobert’s mannouver is effective in what percentage of cases?
90%
What additional measures should be performed if McRobert’s mannouver ineffective?
In the following order:
1) All fours position
2) Internal rotational manouevres (+/- episiotomy)
3) Cleidotomy or symphysiotomy
4) Zavanelli maneuvre
What surgical procedure can be done to help facilitate internal manouevre?
Episiotomy
What is cleidotomy?
Division of foetal clavicle
What is symphysiotomy?
Division of maternal symphysial ligament
What is zavanelli maneuvre?
Replacement of the head into the canal followed by caesarean section
What should be assessed for in mothers following succesful management of shoulder dystocia?
Examine for:
PPH
Perineal tears
Genital tract injury
What should be assessed for in neonatal following succesful management of shoulder dystocia?
Neonatologost to assess for:
Brachial plexus injury
Hypoxia (HIE)
Clavicular and humeral fractures
How does brachial plexus injury present in neonates?
Weakness or paralysis of affected arm
Decreased muscle tone
“Waiter’s tip” arm positioning
Assymetric reflexes
Sensory loss
Brachial plexus injury is also known as?
Erb’s palsy
Which nerves roots in the brachial plexus are affected in Erb’s palsy
C5 and C6
Top part of brachial plexus stretches and gets damaged => loss of flexion in upper limb => Extended elbow
How does clavicular fracture present in neonates?
Pain, swelling, and reduced movement in the affected arm
Tend to self heal overtime
What is the prognosis of brachial plexus injury following shoulder dystocia?
90% fully resolve within a year
