SHOULDER DYSTOCIA “Making the best of a bad situation ”
May 28, 2015
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 !