Shoulder dystocia - kau

Shoulder dystocia - kau

Abdulkareem Fayoumi Definition . Incidence .

Consequences . Risk factors .

Management. 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

Mean time of N delivery 24 sec. Mean time of delivery with dystocia 79 sec.

0.6 1.4 % ( defenition,population and weight ). An obstetric emergency.

Increased maternal morbidity. Increased fetal morbidity & mortality .

PPH ; 11 % - atony -soft tissue trauma ; 3rd & 4th degree tears 3.8% Symphyseal diathesis ( rare )

Uterine rupture ( rare ) Fetal injury ; - brachial plexus injury 4-16 % . - fractures of clavicle and humerus .

Fetal hypoxia ; - neurological damage . - death . 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. Maternal :

previous SD. Obesity. Multiparity. DM. Fetal : Macrosomia

postdate. short stature. IUFD abN pelvic anatomy. Instrumental delivery

NO BUT there is a room for prediction & anticipation. Good glycmic control.

Control weight gain. Identifying risk factors. >50 % of SD cases occur with average weight Babies < 4 kg !!!

so always be ready unpredictable ..unpreventable

Prepare : educate/involve the ptn ahead of delivery. declutter the room . senior person . empty the bladder . STAY CALM !!!

HELPERR Each step 30-60 Sec

For a total Maneuvers) 3- 5 minutes (All 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 1. Increase the size of the bony pelvis

2. Decrease bisacromial diameter 3. Change the relation of bisacromial diameter within the bony pelvis .

Prolonged 1st & 2nd stage of labor. Head bobbing ( turtle sign ), then retracting back in the birth canal.

Minimal downward traction does not affect delivery. Do NOT ask the patient to push.

Do NOT apply fundal pressure. ( Grade C ) Do NOT panic !!

RCOG guidelines..December,2005 Call for help SD work. documentation. Evaluate for Episiotomy

Not for all cases ( Grade B ) Before delivery. Helps when applying the maneuvers RCOG guidelines December,2005 Legs Safe Simple Effective

( McRoberts ) ( used alone resolves 40 % of SD ) Straighten the sacrum. Moves the symphsis pubis toward the maternal head frees the impacted shoulder

Suprapubic Pressure determine the position of the fetal back Initially..continuous CPR-like rocking motion. Enter=internal Maneuvers : Rubin Woods

Screw Rubin I : rocking the fetus shoulder from side to side. Rubin II : reach for the most easily shoulder &

push it forward decrease the bisacromial diameter . Rotate the posterior shoulder 180 degrees

approach post. Shoulder from front. ant. Shoulder from behind. Reverse woods screw posterior shoulder from behind.

Remove the posterior Arm Never grasp / pull on the hand fractures Roll the patient

Might be disorienting for the unfamiliar doctor Increase the obstetric conjugate by 1.5 cm Gravity?? Movement itself?? Same maneuvers can be applied Deliberate clavicular fracture.

Zavenilli maneuver. Symphysiolotmy.

Cleidotomy. Abdominal surgery + hysterotomy (tocolysis,replace head->CS )

( risk of UT/SP injury ) ( with a dead fetus ) reports,same maneuvers ) ( case

Always be ready and calm while dealing with SD. Know your HELPERR

Always document ( time , manuevers used, duration, involved arm ) Now we will move to practice plz!! Thank you!!

Recently Viewed Presentations

  • Beat the World History Public

    Beat the World History Public

    glasnost (openness). These reforms reverberated throughout the communist bloc in Eastern Europe and led to large protests in East Germany, Poland, Hungary, Czechoslovakia and Romania as many sought reforms.
  • The BA/MHS

    The BA/MHS

    The SBI MSPH Program (16-21 mo) The SBI program offers multidisciplinary training for researchers and public health practitioners who wish to use the social sciences in the design, implementation and evaluation of public health programs, particularly community-based interventions.
  • Session 3 Lecture 1 Dynamics of the GIT

    Session 3 Lecture 1 Dynamics of the GIT

    The current human lymphoid system appeared first in jawed fishes. The lymphoid system is most sophisticated in warm-blood birds and mammals. How do lymphocytes accomplish this somatic genetic modification? ... win the battle against bacteria and save humanity!
  • Principles of Epidemiology CORE 5520 (32:832:520)

    Principles of Epidemiology CORE 5520 (32:832:520)

    Principles of Epidemiology Lecture 10 ... interview questions Potential confounders need to be accurately assessed in order to be controlled in the analysis Odds Ratio (OR) A ratio that measures the odds of exposure for cases compared to controls Odds...
  • City of Mandeville Sign ordinances

    City of Mandeville Sign ordinances

    visual and aesthetic quality . of the community in accord with the character of the City of Mandeville and the surrounding area through the establishment and enforcement of standards for the design, quality of materials, construction, location, electrification, illumination and...
  • Advanced Placement Government &amp; Politics

    Advanced Placement Government & Politics

    AP Gov Exam: The Basics. Essential Question: How is the exam structured? Two sections: Multiple Choice = 60 questions in 45 minutes. (50% of Exam) Free Response Questions = 4 F.R.Q.s in 100 minutes (think 25 minutes each) (50% of...
  •  1980    .   ,   Alexis Colby  .      look .

    1980 . , Alexis Colby . look .

    Αγαπημένα παπούτσια είναι τα αθλητικά εταιρειών όπως η Reebok, Nike, L.A Gear και Keds. 29 ΜΑΚΙΓΙΑΖ :Τα φρύδια είναι φυσικά και παχιά.


    Fixed Salary calculator - Managers. Alternatively you can use pre-programmed software that will calculate any information about your salary and calculate the final outcome. This calculator just relies on you entering your salary (amount per year) and the calculator will...