Shoulder dystocia / distocija fetlnih ramena

SHOULDER DYSTOCIA

“Making the best of a bad situation ”

CONTENT

1. Definition

2. Types of dystocia

3. Risk factors

4. Diagnosis

5. Complications

6. Brachial plexus injury

7. Maternal complications

8. Action !

9. Who’s the boss?

10. H.e.l.p.e.r.r.

11. …..

12. Maneuver

13. Mcroberts maneuver

14. Suprapubic pressure

15. All-fours maneuver

16. Swatz-barnum maneuver

17. Zavanelli maneuver

18. Prophylactic cesarean?

19. Questions ?

20. SUMMARY

Definition

Complication of vaginal delivery – 1730 .

Difficulty in delivery of fetal shoulders

Fetal shoulders get stuck

Types of dystocia

Bilateral shoulder dystocia Unilateral shoulder dystocia

Risk factors

- D . O . P . E

- Unpredictable :

- 25-50% have no defined risk factor!

Diagnosis

’’Turtle sign ’’

involves the appearance and retraction of the fetal head

Complications

Fetal complications

- Brachial plexus injury - Fetal Fractures- Asphyxia/cord compression

Brachial plexus injury

Maternal complications

-Postpartum hemorrhage

- 4th degree laceration

Action !

We need :

Attending physician Anesthesiologist Pediatrician Nursing Staff “Extra Hands

Who’s the Boss?

the most experienced person in the room

Attending physician

H.E.L.P.E.R.R.

Call for Help

Episiotom

Legs (McRoberts)

Suprapubic Pressure

Enter (Internal Maneuvers)

- Swatz-Barnum maneuver

Remove: Delivery posterior arm

Roll the patient

Maneuver

There are three ways of relieving shoulder:

1. First - external(Mc Roberts,suprapubic pressure, All-fours maneuver)

2. Second - inner, vaginal maneuver( Swatz-Barnum maneuver )

3. Third - combined abdominal-vaginal maneuver (Zavanelli maneuver)

McRoberts Maneuver

- Decreases the angle of pelvic inclination

- Cephalic rotation of the pelvis

Suprapubic Pressure

All-fours maneuver

in the knee-elbow position expand the capacity of the pelvis by about 30%

Swatz-Barnum maneuver

Zavanelli maneuver

Prophylactic Cesarean?

Exceptions: Consider if…

>5000g in mother without DM

>4500g in mother with DM

Questions :

1) Which algorithm do we use to solve this emergency

situations ?

H.E.L.P.E.R.R.

2) Sign which helps in the diagnosis of fetal dystocia is

TURTLE SIGN

SUMMARY :

Cannot accurately predict

BE PREPARED!

Consider risk factors Be quick !