Shoulder dystocia: Difference between revisions
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==Background== | ==Background== | ||
Occurs in 0.2 to 3 percent of all births | |||
==Clinical Presentation== | ==Clinical Presentation== | ||
Revision as of 19:27, 31 May 2015
Background
Occurs in 0.2 to 3 percent of all births
Clinical Presentation
Differential Diagnosis
- Emergent delivery
- Umbilical cord prolapse
- Breech delivery
- Shoulder dystocia
- Perimortem cesarean delivery
Diagnosis
Treatment
- No method of delivery has been shown to be better or safer
HELPER
- H call for help
- E episiotomy (or episioproctotomy) to increase the anetroposterior diameter of passage
- L Legs flex (McRoberts maneuver)
- P Pressure- suprapubic pressure and Rubin’s maneuver (applying shoulder pressure to the fetus to decreases the bisacromial diameter)
- E Enter the vagina and attempt Wood’s corkscrew maneuver by pushing the most accessible shoulder toward the chest to corkscrew the shoulders through
- R Remove posterior arm by sweeping it across the chest and bring fetal hand to the chin, grasp and pull out of the birth canal and across the face
Complications
- Transient brachial plexus palsy (3.0 to 16.8 percent)
- Clavicular fracture (1.7 to 9.5 percent)
- Humerus fracture (0.1 to 4.2 percent)
- Permanent brachial plexus palsy (0.5 to 1.6 percent)
- Hypoxic-ischemic encephalopathy (0.3 percent)
- Death (0 to 0.35 percent)