Shoulder dystocia is when, after vaginal delivery of the head, the baby's anterior shoulder gets caught above the mother's pubic bone.[3][1] Signs include retraction of the baby's head back into the vagina, known as "turtle sign".[1] Complications for the baby may include brachial plexus injury, or clavicle fracture.[2][1] Complications for the mother may include vaginal or perineal tears, postpartum bleeding, or uterine rupture.[3][1]
Risk factors include gestational diabetes, previous history of the condition, operative vaginal delivery, obesity in the mother, an overly large baby, and epidural anesthesia.[2] It is diagnosed when the body fails to deliver within one minute of delivery of the baby's head.[2] It is a type of obstructed labour.[4]
Shoulder dystocia is an obstetric emergency.[3] Initial efforts to release a shoulder typically include: with a woman on her back pushing the legs outward and upward, pushing on the abdomen above the pubic bone, and making a cut in the vagina.[3] If these are not effective, efforts to manually rotate the baby's shoulders or placing the woman on all fours may be tried.[3][2] Shoulder dystocia occurs in approximately 0.4% to 1.4% of vaginal births.[2] Death as a result of shoulder dystocia is very uncommon.[1]
The steps to treating a shoulder dystocia are outlined by the mnemonic ALARMER:[10]
- Ask for help. This involves asking for the help of an obstetrician, anesthesia, and for pediatrics for subsequent resuscitation of the infant that may be needed if the methods below fail;
- Leg hyperflexion and abduction at the hips (McRoberts maneuver);
- Anterior shoulder disimpaction (suprapubic pressure);
- Rotation of the shoulder (Rubin maneuver);
- Manual delivery of posterior arm;
- Episiotomy;
- Roll over on all fours.
Wont be able to deliver the shouder with the usual traction. then can diagnose shoulder dystocia,
IT is not absolute that a baby above 4kg will have shoulder dystocia and not absolute that a baby about 3.5 kg will have shoulder dystocia
Risk factors can be studied but cannot be used to prevent shouder dystocia. Instead can only etter prepare for it.
defintion of macrosomnia?
Hypertension doesnt increase risk of shoulder dystocia
Gestational age does but in this case doesnt as gentational is normal in this case
Uterine fibroids can cause shoulder dystocia but in this case they are asking risk factor for the diagnosis...which is not relatively speaking becaue uterine fibroids can cause diifccicuty in delivering any part.
Head retracting into the perinuem is called the turtles sign
epistomy wont help with shoulder dstocia...to deliver the hsoulder since the shoulders arent stuck behind the perinuem but behind the pubis bone. But eistony hels in creating more space to put hands and do manouvres.
Problem with shoulder dystocia is that it compresses the cord mainly leading to hypoxia and also alos compressess chest, leading to respiratory failure.
Pushing down and pulling from below can cause problems to the shoulder and cause brachal nrve palsy as well.
so need atleast 3 people...one for each thigh and one to apply suprapubic pressure. or 2 with one rasiing one leg and apply supra pubic pressure.
the main thing is to lessen the diamaters of the shoulder so can sqeeze through.
Majority of the time the above manouvre works.
More space is created posteriosily and more space for the shoulder to slip out.
dring hyperflexion its sqeezed betweeb the lateral aspect of ASIS and the inguinal ligament
when the posterior arms are delivered, the diameter f the shoulder shortens so easier to deliever the anterioir shoulder.
Rubins manouvere is the same thing that would be done with supra pubic preessure = applying pressure to lessen the diameter of the shoulders so can easily deliver. but this time from inside putting and pulling.
epis can help with the above manoevre but epis by itself wont help with shoulder dystocia.
For woods corkscrew make sure you rotate the entire baby...so that the arm can rotate and occupy a psace more posterior.
Why diabetes leads to shoulder dystocia ⇒ because maternal gdm leads to macromsinia but this macro is focused on the abdomen and stuff and not the head. small head anyways. so head can deliver easily but the rest get stuck.
zavanelli is putting the head back into the vagina up and then doing a ceasrian section.
...
most common position is LOP ....so the back of the head is facing left side and the right arm is above. so most commonly right arm gets stuck so leads to right arm lesions.
Mc injury is brachial plexus injury but other injuries also can happen = like when delivering the posterior arm can injure the clavicle etc
PPH because of the condiitons leading to SD and also because of all the manipulaions and manouvres.
So after delivery, the obs should keep eyes open for sd and peads should keep eyes open for any neonatal neurological ul deficits and any other injuries.
