O+G
SHOULDER DYSTOCIA
PromptDescribe and explain the importance of shoulder dystocia
ResponseBaby’s head delivered but unable to deliver the shoulder. Turtle sign = shoulder dystocia. (ie: head goes out but then back in again)
Anatomic issue = bony impaction of anterior shoulder behind pubic symphesis (not soft tissue, its bony)
Deliver baby within 5 (?10) min to avoid serious foetal hypoxia
Cord comperssion >> lack of bloodflow>> hypoxia
Consequence = hypoxic ischaemic encephalopathy or death
Anatomic issue = bony impaction of anterior shoulder behind pubic symphesis (not soft tissue, its bony)
Deliver baby within 5 (?10) min to avoid serious foetal hypoxia
Cord comperssion >> lack of bloodflow>> hypoxia
Consequence = hypoxic ischaemic encephalopathy or death
Promptmanagement/maneuvers to help delivery in shoulder dystocia
ResponseHELPERR mnemonic
H - Call for help
E - Evaluate for episiotomy (typically to allow space for internal maneuvers), End pushing
L - Legs (McRoberts Maneuver) - lie mother flat, flexa nd abduct hips until thighs are on abdomen (opens/straightens birth canal) - “legs up knees to nipples”
P - Pressure - suprapubic pressure press down and lateral to adduct the foetus shoulder.
E - Enter for internal manouvers - woods screw - hand enters posterior and internally rotates
R - Remove posterior arm - Foetal wrist grasped and pulled out in straight line
R - Roll onto hands and knees
?? something about breaking clavicle intentionally
H - Call for help
E - Evaluate for episiotomy (typically to allow space for internal maneuvers), End pushing
L - Legs (McRoberts Maneuver) - lie mother flat, flexa nd abduct hips until thighs are on abdomen (opens/straightens birth canal) - “legs up knees to nipples”
P - Pressure - suprapubic pressure press down and lateral to adduct the foetus shoulder.
E - Enter for internal manouvers - woods screw - hand enters posterior and internally rotates
R - Remove posterior arm - Foetal wrist grasped and pulled out in straight line
R - Roll onto hands and knees
?? something about breaking clavicle intentionally