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Shoulder Dystocia

Shoulder Dystocia.

QuestionAnswer
Define shoulder dystocia. Impaction of the anterior shoulder against the maternal symphysis pubis after the head is birthed.
Define bisacromial diameter. Breadth of the shoulders.
What are the causes for shoulder dystocia? Bisacromial diameter that exceeds the diameter of the pelvic inlet, Heasd to body time intervals ≥ 60sec, The use of ancillary procedures to effect birth.
Is the incidence of shoulder dystocia high? No it is reported to be between 0.6 - 1.4%.
What is known to increase the incidence of shoulder dystocia? Higher fetal weight 4000g-4500 especially those over.
What is the risk factors associated with shoulder dystocia? Shoulder dystocia with previous baby, Gestational diabetes, Post dates pregnancy, Macrosomia - fetal weight over 4500g, High prepregancy weight or weight gain, Instrumental or vacuum delivery, Long 1st stage or prolonged 2nd stage of labour, Short
How is shoulder dystocia identified? The "turtle sign" fetal head appears to want to go back into the vagina and it retracts against the perineum. Usual traction on the baby's head does not result in the delievery of the shoulders. Head to body time interval of ≥ 60 sec.
Define the HELPERR mnemonic involving shoulder dystocia. H=Help E=Episiotomy L=Legs P=Pressure E=Enter R=Remove R=Roll.
During the H - Help phase in the HELPERR mnemonic for shoulder dystocia, notification of the hospital is important for them to activate which individuals? Additional midwifery staff. Neonatal resus team. Obstetrical/surgical team. Anaesthetist.
Will episiotomy release the shoulder in a shoulder dystocia case? No shouler dystocia is a bony impaction.
In many cases what two maneuvers many relieve shoulder dystocia cases? McRoberts and suprapubic pubic pressure.
What is McRoberts maneuver? The woman lies flat on her back, then flexes her hips touching her knees to her chest or "knees to nipples"
For how long should the McRoberts maneuver be attempted for before moving on? 30-60 seconds.
In the P-Pressure stage for shoulder dystocia what should be performed? Suprapubic pressure by an assistant.
What is the objective of suprapubic pressure on the child? To move the baby's shoulders from the anterior-posterior diameter of the pelvis to the oblique diameter which is larger.
During the H - Help phase in the HELPERR mnemonic for shoulder dystocia, notification of the hospital is important for them to activate which individuals? Additional midwifery staff. Neonatal resus team. Obstetrical/surgical team. Anaesthetist.
Will episiotomy release the shoulder in a shoulder dystocia case? No shouler dystocia is a bony impaction.
In many cases what two maneuvers many relieve shoulder dystocia cases? McRoberts and suprapubic pubic pressure.
What is McRoberts maneuver? The woman lies flat on her back, then flexes her hips touching her knees to her chest or "knees to nipples"
For how long should the McRoberts maneuver be attempted for before moving on? 30-60 seconds.
In the P-Pressure stage for shoulder dystocia what should be performed? Suprapubic pressure by an assistant.
What is the objective of suprapubic pressure on the child? To move the baby's shoulders from the anterior-posterior diameter of the pelvis to the oblique diameter which is larger.
HELPERR- R, ROll the patient. What is the reason for rolling the patient onto all fours or into the McRobert's position? It increases pelvic diameter. Movement and gravity may also contribute to dislodging the impaction of the shoulder.
Which shoulder in the shoulder dystocia case should be delivered first? The posterior shoulder.
What is the role of the paramedic in the shoulder dystocia case? 1. Try McRoberts.Get assistance in bringing her knees to her chest, avoid applying too much traction to the head. 2. Have assistant suprapubic pressure while you apply downward traction to the head. 3.Get pt on all 4's. Deliver posterior shoulder first.
Created by: boermedic