Recommended
More Related Content
What's hot
What's hot (20)
Similar to Shoulder dystocia 29.12.2020
Similar to Shoulder dystocia 29.12.2020 (20)
Recently uploaded
Recently uploaded (20)
Shoulder dystocia 29.12.2020
- 1. Shoulder Dystocia Uma Kole Asst. Professor KAHER INS
- 2. Definition Shoulder dystocia is a complication of vaginal birth in which shoulder gets impacted into maternal pelvis
- 3. Shoulder Dystocia • Shoulder dystocia occurs when after delivery of the fetal head additional obstetrical maneuvers are required to deliver the fetal shoulders
- 7. Risk factors Fetal macrosomia Obesity GestationalDiabetes Midpelvic instrumental delivery Post maturity >42 weeks Multiparity Anencephaly Fetal ascites Previous history of Shoulder dystocia
- 8. Diagnosis Routine practice of gentle downward traction of the fetal head fails to deliver anterior shoulder
- 9. Warning Signs and Diagnosis
- 10. Deliver the infant before the asphyxia from umbilical cord compression, without causing any fetal or maternal trauma
- 11. Management principles DONTs’: • Do not be panick • Do not give traction over baby’s head • Do not apply fundal pressure Dos’ • Call for extra help • Clear the infant’s mouth and nose • Involve the anesthetist and the pediatrician • Perform episiotomy if not performed earlier
- 12. Management
- 13. Case study Mrs. Laxmi • 26 years old • G1@40 weeks of gestation • Healthy-No medications • Normal pregnancy • Fully dilated –pushing x2hrs
- 15. 1. Pre-procedure steps and considerations: – Shout for help – Explain procedure – Follow general principles of basic care and infection prevention – Perform episiotomy Management
- 19. EXTERNAL PRESSURE Apply pressure suprapubicaly with palm or fist, dierecting the pressure on anterior shoulder both downword & laterally Suprapubic pressure is supposed to adduct the shoulders or bring them into an oblique plane Since the oblique diameter is the widest diameter of the pelvis
- 20. • If the shoulder is still not delivered: insert a hand into the vagina and apply pressure to the anterior shoulder in the direction of the baby’s sternum to rotate the shoulder and decrease the shoulder diameter. Rubin’s Maneuver
- 21. Rubin II Inserting fingers of ONE hand behind most accessible fetal shoulder Pushing shoulder toward the fetus’chest Collapse of shoulder girdle
- 22. Wood’s maneuver
- 23. Wood’s maneuver If the shoulder is still not delivered despite the above measures: • Progressively rotating the posterior shoulder 180 degree in corkscrew fashion • The impacted anterior shoulder could be released
- 24. REMOVE THE POSTERIOR ARM • Flex arm at elbow • Apply pressure in anticubital fossa to flex arm • Sweep arm over chest • Grasp risk, forearm or hand • Deliver arm
- 26. LAST RESORT OPTIONS Fracture of the fetal clavicle Zavenelli maneuver(returning the fetal head and attempting the caesarian delivery) Symphysiotomy
- 27. Fetal Complications • Fetal fractures-humerus/clavicle • Brachial plexus injury • Erb’s palsy • Perinatal asphyxia • Neonatal death
- 28. Documentation Keeping Time is Imperative Note time of delivery of head Time kept for each maneuver of 30-60 seconds Total time to delivery and mode of delivery Who is in the room when new providers are called/activated and enter the room Is FH still obtainable and what it is Use all information for written documentation after delivery, including discussion with patient about what occurred
- 29. Case study-Laxmi
- 30. 1. Pre-procedure steps and considerations: – Shout for help – Explain procedure – Follow general principles of basic care and infection prevention – Perform episiotomy Management
- 32. EXTERNAL PRESSURE Apply pressure suprapubicaly with palm or fist, dierecting the pressure on anterior shoulder both downword & laterally Suprapubic pressure is supposed to adduct the shoulders or bring them into an oblique plane Since the oblique diameter is the widest diameter of the pelvis