SHOULDER DYSTOCIA SALSO COURSE Sarawak General Hospital
SHOULDER DYSTOCIA <ul><li>Anterior shoulder impacts against the symphysis pubis after the fetal   head has delivered </li>...
INCIDENCE <ul><li>Overall 0.3 - 1.0% </li></ul><ul><li>BW > 4.0 kg 5.0 - 7.0% </li></ul><ul><li>BW > 4.5 kg 8.0 - 10.0% </...
MECHANISM <ul><li>Normal: Head through pelvic outlet, shoulders enter pelvic inlet in oblique diameter with posterior shou...
MATERNAL  RISK FACTORS <ul><li>Previous shoulder dystocia  </li></ul><ul><li>Macrosomia (known, suspected, previous) </li>...
LABOUR RISK FACTORS <ul><li>Prolonged first stage </li></ul><ul><li>Prolonged second stage </li></ul><ul><li>“Head bobbing...
TREATMENT <ul><li>Anticipation and preparation </li></ul><ul><li>Avoid fundal pressure, excessive traction, twisting neck,...
HELPERR <ul><li>H  Help </li></ul><ul><li>E  Episiotomy </li></ul><ul><li>L  Legs: McRobert’s Manoeuver (30-60sec) </li></...
MATERNAL COMPLICATIONS <ul><li>3rd degree tear </li></ul><ul><li>Vaginal lacerations </li></ul><ul><li>Postpartum haemorrh...
FETAL COMPLICATIONS <ul><li>Brachial plexus injury </li></ul><ul><ul><li>Erb’s palsy:5th and 6th cervical roots </li></ul>...
Upcoming SlideShare
Loading in...5
×

Shoulder Dystocia

7,737

Published on

SALSO Series - Shoulder Dystocia

Published in: Health & Medicine
0 Comments
5 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
7,737
On Slideshare
0
From Embeds
0
Number of Embeds
5
Actions
Shares
0
Downloads
0
Comments
0
Likes
5
Embeds 0
No embeds

No notes for slide

Shoulder Dystocia

  1. 1. SHOULDER DYSTOCIA SALSO COURSE Sarawak General Hospital
  2. 2. SHOULDER DYSTOCIA <ul><li>Anterior shoulder impacts against the symphysis pubis after the fetal head has delivered </li></ul><ul><li>Life threatening </li></ul><ul><li>Risk factors have low predictive value </li></ul><ul><li>Be prepared for shoulder dystocia in all deliveries </li></ul>
  3. 3. INCIDENCE <ul><li>Overall 0.3 - 1.0% </li></ul><ul><li>BW > 4.0 kg 5.0 - 7.0% </li></ul><ul><li>BW > 4.5 kg 8.0 - 10.0% </li></ul><ul><li>> 50% occurs in normal birthweight infant (< 4.0 kg) and is unanticipated (Obstet Gynaecol 1985, 66:762-8) </li></ul><ul><li>Recurrence 1.5 - 14 % </li></ul>
  4. 4. MECHANISM <ul><li>Normal: Head through pelvic outlet, shoulders enter pelvic inlet in oblique diameter with posterior shoulder in sacral hollow </li></ul><ul><li>Problem: at pelvic inlet </li></ul><ul><li>Shoulder dystocia: Anterior shoulder remains hooked behind symphysis pubis and fails to rotate into a larger pelvic diameter (oblique or transverse) </li></ul>
  5. 5. MATERNAL RISK FACTORS <ul><li>Previous shoulder dystocia </li></ul><ul><li>Macrosomia (known, suspected, previous) </li></ul><ul><li>Diabetes </li></ul><ul><li>Prepregnancy weight > 80kg </li></ul><ul><li>Weight gain > 20kg </li></ul><ul><li>Advanced maternal age </li></ul><ul><li>Post term pregnancy </li></ul><ul><li>Anencephaly </li></ul><ul><li>Short stature </li></ul><ul><li>Small or abnormal pelvis </li></ul>
  6. 6. LABOUR RISK FACTORS <ul><li>Prolonged first stage </li></ul><ul><li>Prolonged second stage </li></ul><ul><li>“Head bobbing” (Turtle sign) during second stage </li></ul><ul><li>Instrumental delivery </li></ul>
  7. 7. TREATMENT <ul><li>Anticipation and preparation </li></ul><ul><li>Avoid fundal pressure, excessive traction, twisting neck, bending neck </li></ul><ul><li>pH of fetus drops 0.04 per minute. </li></ul><ul><li>7 minutes of cord compression will drop the pH by 0.28 </li></ul><ul><li>As pH approaches 7.0, resuscitation becomes increasingly difficult </li></ul>
  8. 8. HELPERR <ul><li>H Help </li></ul><ul><li>E Episiotomy </li></ul><ul><li>L Legs: McRobert’s Manoeuver (30-60sec) </li></ul><ul><li>P Pressure: Suprapubic (30-60sec) </li></ul><ul><li>E Enter: Woods Screw Manoeuver (30-60sec) </li></ul><ul><li>R Remove the posterior arm </li></ul><ul><li>R Roll: the patient to hands and knees </li></ul><ul><li>(Fracture clavicle, Symphysiotomy, Zavanelli abdominal replacement) </li></ul>
  9. 9. MATERNAL COMPLICATIONS <ul><li>3rd degree tear </li></ul><ul><li>Vaginal lacerations </li></ul><ul><li>Postpartum haemorrhage </li></ul><ul><li>Uterine rupture </li></ul>
  10. 10. FETAL COMPLICATIONS <ul><li>Brachial plexus injury </li></ul><ul><ul><li>Erb’s palsy:5th and 6th cervical roots </li></ul></ul><ul><ul><li>Klumpke’s: 8th cervical and 1st thoracic roots </li></ul></ul><ul><li>Fractures </li></ul><ul><ul><li>Clavicle </li></ul></ul><ul><ul><li>Humerus </li></ul></ul><ul><li>Fetal Hypoxia </li></ul><ul><li>Death </li></ul>

×