Recommended
More Related Content
What's hot
What's hot (20)
Similar to Shoulder Dystocia 2018
Similar to Shoulder Dystocia 2018 (20)
More from Kervindran Mohanasundaram
More from Kervindran Mohanasundaram (20)
Recently uploaded
Recently uploaded (20)
Shoulder Dystocia 2018
- 1. 5
- 3. GOALS 1. Understand the risk factors associated with shoulder dystocia 2. Able to diagnose & manage shoulder dystocia 3. Documentation & risk management to reduce obstetric litigation
- 4. DEFINITION Shoulder dystocia is the impaction of the anterior shoulder against the symphysis pubis after the head has been delivered Occurs when the breadth of the shoulder is greater than the biparietal diameter of the head. Diagnosed when any of the obstetric maneuver is needed to release the shoulder after gentle axial traction has failed
- 5. One of the most dreaded obstetric complications It is one of the primary causes of perinatal mortality and morbidity, maternal morbidity and a costly source of litigation. One must be prepared for the possibility of shoulder dystocia in all deliveries, and have a prepared plan of management. Incidence: Varies; 6 in 1000 (RCOG 2012)
- 7. RISK FACTORS Antepartum risks Macrosomia Maternal diabetes Previous history of shoulder dystocia Maternal obesity Induction of labour Intrapartum risks Prolonged first stage Secondary arrest Prolonged second stage Oxytocin augmentation Assisted vaginal delivery
- 8. **However, most cases occur without risk factors. Therefore, all clinicians need to be prepared for unexpected shoulder dystocia at all deliveries **
- 9. Early detection “Head bobbing": the head coming down towards the introitus with pushing, but retracting back between contraction “Turtle sign at delivery": The delivered head becomes tightly pulled back against the perineum
- 10. COMPLICATIONS MATERNAL Perineal trauma Uterine atony Uterine rupture PPH FETUS Brachial plexus injury Clavicle or humerus fracture Neurological deficit / HIE Death
- 11. Shoulder Dystocia: The drill
- 12. Suprapubic pressure The direction of pushing should be in the direction of where the baby is facing
- 14. Deliver The Posterior Arm Flex the forearm at the elbow if the forearm is extended. Deliver the arm by sweeping it across the chest and face.
- 15. ROLL OVER This position is called “on all-fours”, or Gaskin’s manoeuvres, knee-chest position or hands-and-knee position. REPEAT Repeat the above procedures from McRoberts maneuver If the above maneuvers are unsuccessful, all maneuvers may be tried again. The order is which each and the entire manoeuvre is attempted may be revised.
- 16. If all procedures fail……. Symphysiotomy – cutting the symphysis pubis to allow delivery of the anterior shoulder Clavicular fracture (@cleidotomy) – allows further adduction of the fetal shoulder, reducing the diameter of the shoulders, thus allowing delivery Zavanelli maneuvre – push the baby’s head back into the uterus and proceed with emergency caesarean
- 17. Post delivery Watch-out for complications Counseling for both patient and partner Documentation - Accurate & comprehensive - Important to document which fetal shoulder was anterior