21. Questions :
1) Which algorithm do we use to solve this emergency situations
?
H.E.L.P.E.R.R.
1) Sign which helps in the diagnosis of fetal dystocia is
TURTLE SIGN
BILATERAL :The posterior shoulder is not in the hollow of the pelvis. If the sacral promontory also obstructs the posterior shoulder, bilateral (and more difficult) shoulder dystocia occurs.
UNILATERAL : dystocia is usually easily dealt with by standard techniques.
D - Diabetes
O- Obesity
P- Post term pregnancy, prior large baby
E- Excessive weight gain during pregnancy
One often described feature is the turtle sign which involves the appearance and retraction of the fetal head (analogous to a turtle withdrawing into its shell) and the erythematous, red puffy face indicative of facial flushing.
Fractures of humerus or clavicle
Brachial plexus injury (Erb’s/Klumpke’s palsy)
Brachial plexus injury is a loss of movement or weakness of the arm that occurs when the collection of nerves around the shoulder are damaged during birth.
4th = damage to vagina , perineal body , anal sphincter and rectal mucosa
Goal: Safe delivery before neontal asphyxia and/or cortical injury
-should be the only one giving orders.
TAKE YOUR TIME, THIS IN AN EMERGENCY, BUT IT IS NOT A RACE!!!
H: Call for Help; Shoulder dystocia is called if shoulders cannot be delivered with gentle traction
E: Evaluate for Episiotomy: Not routinely indicated; maybe needed when attempting intra-vaginal maneuver
L: Legs (McRoberts): Hyperflexion and abduction of hips—initial maneuver
P (Suprapubic Pressure): No fundal pressure; combination of McRoberts and suprapubic pressure resolves most shoulder dystocias( together more than 60% )
Enter (Internal Maneuvers): oblique diameter rotational maneuvers
Remove: Delivery posterior arm
Roll the patient: Gaskin maneuver or all four positions
42% success rate
Marked flexion of the maternal thighs unto the abdomen
2. .... frees the anterior shoulder
Moderate suprapubic pressure. Stronger pressure can only be exerted by an assistant.
Combine with McRoberts
Delivery of posterior arm
Consists of cephalic replacement and then cesarean delivery
