shoulder dystocia
DESCRIPTION
Shoulder dystocia. Abdulkareem Fayoumi. OBJECTIVES :. Definition . Incidence . Consequences . Risk factors . Management. Definition. A head-to-body delivery time > 60 seconds due to impaction of the shoulder ( anterior )against the symphsis pubis. Williams Ob - PowerPoint PPT PresentationTRANSCRIPT
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Abdulkareem Fayoumi
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Definition .
Incidence .
Consequences .
Risk factors .
Management.Management.
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A head-to-body delivery time > 60 seconds due to impaction of the shoulder ( anterior )against the symphsis pubis.
Williams Ob
Use of any of the obstetric maneuvers to release the shoulder after gentle downward traction has failed.
RCOG ,2005
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Mean time of N delivery 24 sec.
Mean time of delivery with dystocia 79 sec.
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0.6 – 1.4 % ( defenition,population and weight ).
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An obstetric emergency.
Increased maternal morbidity.
Increased fetal morbidity & mortality .
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PPH ; 11 % - atony -soft tissue trauma ; 3rd & 4th degree tears 3.8%
Symphyseal diathesis ( rare )
Uterine rupture ( rare )
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Fetal injury ; - brachial plexus injury 4-16 % .
- fractures of clavicle and humerus .
Fetal hypoxia ; - neurological damage .
- death .
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4-6 % .Due to downward traction on the neck . Most important fetal effect .Most common cause for litigation in SD .Independent of operator experience . GOOD NEWS >80 % of cases have complete resolution by 6-13 months.
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Maternal : previous SD. Obesity. Multiparity.
DM.
short stature.
abN pelvic anatomy.
Fetal :
Macrosomia
postdate.
IUFD
Instrumental delivery
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NO BUT there is a room
for prediction & anticipation.
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Good glycmic control.
Control weight gain.
Identifying risk factors.
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>50 % of SD cases occur with average weight
Babies < 4 kg !!!
so always be ready… unpredictable ..unpreventable
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Prepare :
educate/involve the ptn ahead of delivery. declutter the room . senior person . empty the bladder . STAY CALM !!! HELPERR
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Each step 30-60 Sec
For a total 3- 5 minutes (All Maneuvers)
No indication that any of these maneuvers is superior, they represent a valuable tool to help clinicians take effective steps to relieve impacted shoulder ( Category C )
ACOG..October 1997
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1. Increase the size of the bony pelvis
2. Decrease bisacromial diameter
3. Change the relation of bisacromial diameter within the bony pelvis .
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Prolonged 1st & 2nd stage of labor.
Head bobbing ( turtle sign ), then retracting back in the birth canal.
Minimal downward traction does not affect delivery.
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Do NOT ask the patient to push.
Do NOT apply fundal pressure. ( Grade C )
Do NOT panic !!
RCOG guidelines..December,2005
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Call for help SD drill..team work.
documentation.
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Evaluate for
EpisiotomyNot for all cases ( Grade B )
Before delivery.
Helps when applying the maneuvers
RCOG guidelines December,2005
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Legs ( McRobert’s )
SafeSimple Effective ( used alone resolves 40 % of SD )
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•Straighten the sacrum.
•Moves the symphsis pubis toward the maternal head frees the impacted shoulder
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Suprapubic Pressuredetermine the position of the fetal back
Initially..continuous
Then..in CPR-like rocking motion.
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Enter=internal Maneuvers :
RubinWood’s Screw
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Rubin I :Rubin I :rocking the fetus shoulder from side to side.
Rubin II :Rubin II : reach for the most easily shoulder & reach for the most easily shoulder & push it forward decrease the push it forward decrease the
bisacromial diameter .bisacromial diameter .
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Rotate the posterior shoulder 180 degrees
approach post. Shoulder from front. ant. Shoulder from behind.
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Reverse wood’s screw
posterior shoulder from behind.
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Remove the posterior Arm
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Never grasp / pull on the hand
fractures
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Roll the patient
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•Might be disorienting for the unfamiliar doctor
•Increase the obstetric conjugate by 1.5 cm
•Gravity?? Movement itself??
•Same maneuvers can be applied
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Deliberate clavicular fracture.
Zavenilli maneuver. (tocolysis,replace head->CS )
Symphysiolotmy. ( risk of UT/SP injury )
Cleidotomy. ( with a dead fetus )
Abdominal surgery + hysterotomy ( case reports,same maneuvers )
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Always be ready and calm while dealing with SD.
Know your HELPERRyour HELPERR
Always document ( time , manuevers used, duration, involved arm )
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Now …we will move to practice plz!!
Thank you!!