SHOULDER DYSTOCIA
➡️ Obstetrical Emergency
Definition;
Shoulder dystocia is an obstetrical emergency where the baby’s head is delivered BUT The anterior shoulder gets trapped behind the symphysis pubis and the baby is stuck!
We have 3 to 5 minutes to get baby out!
HARAKA HARAKA! IN KISWAHILI
🔻Predisposing Factors
(1) Large baby
(2) Maternal diabetes
(3) Maternal obesity
(4) Post-term pregnancies
(5) High parity
(6) Maternal age >35 years
(7) Previous shoulder dystocia
(8) Births of babies >4500 grams to mothers with diabetes have up to 50% shoulder dystocia
🔻Complications of Shoulder Dystocia
(a) Maternal
-postpartum hemorrhage
- rectovaginal fistula
- separation of symphysis pubis
- 3rd or 4th degree tear
- uterine rupture
(b) Fetal
- fetal death
- fetal hypoxia
- brachial plexus palsy
- clavicle fracture
- fracture of humerus
Recognize the TURTLE SIGN!
I think for midwifery student you know this "Turtle Sign"
Mnemonic: HELPERR
H- Help
E- Evaluate for episiotomy
L- Legs in McRoberts position
P- Suprapubic Pressure
E- Enter vagina (internal rotation &posterior arm)
R- Rotate (on to all fours)
R- Repeat
Get Help!
Have someone call for help
Look at the clock and ask someone to keep track of how many minutes have passed
Begin with non-invasive procedures
AVOID – pushing, pulling baby
NO fundal pressure!
Change the Mother’s Position - #1
LEGS
Any change may be helpful to release the shoulders
Help move mother into a position that opens the pelvis to a bigger space
McRobert’s Position
Legs to the sides and elevated
McRobert’s Position
McRobert’s Opens the Pelvis Wider!
Try Gentle Pressure Downwards to Deliver Anterior Shoulder
Step #2 - Suprapubic Pressure
Helper applies suprapubic pressure on the back of the anterior shoulder. This helps baby to turn.
This may free the shoulder!
Suprapubic Pressure – use the palm. Sustained pressure or rocking
#3) Enter Vagina: Internal maneuvers to turn baby and free the shoulders!
Rotate Anterior Shoulder
#4) Deliver the Posterior Arm
Deliver The Posterior Arm
– locate posterior arm
– direct it into the empty sacrum
– splint the wrists and forearm
– sweep across the chest to deliver
– this reduces the diameter of the shoulders
#5) Rotate onto Hands & Knees
The Gaskin Maneuver Repeat the maneuvers!
Maneuvers of Last Resort
If possible prevent injury to the neonate
Fracture clavicle of the baby
Symphysiotomy
But midwives and nurses are good with their hands! Practice to become highly skilled at management of shoulder dystocia!
Stay Calm
NO Pushing or Pulling
– Pulling harder will not free the shoulder
– It will get more stuck!
– Do not apply fundal pressure
Practice as a team to be prepared in the event of emergency
Review - HELPERR
☑️ Summary
Birth attendant has 5 minutes after delivery of the head before the baby develops acidosis and hypoxia
No single maneuver more effective or safer
Try each maneuver for 30 seconds
If not immediately successful move to the next maneuver
MIDWIFERY COURSE PDF NOTES
11. Cord Prolapse and Presentation
13. Pre-eclampsia and Eclampsia
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