Shoulder dystocia: Difference between revisions
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'''HELPER''' | '''HELPER''' | ||
*'''H''' call for help | *'''H''' call for help | ||
*'''E''' episiotomy (or episioproctotomy) to increase the | *'''E''' episiotomy (or episioproctotomy) to increase the anteroposterior diameter of passage | ||
*'''L''' Legs flex (McRoberts maneuver) | *'''L''' Legs flex (McRoberts maneuver) | ||
*'''P''' Pressure- suprapubic pressure and Rubin’s maneuver (applying shoulder pressure to the fetus to decreases the bisacromial diameter) | *'''P''' Pressure- suprapubic pressure and Rubin’s maneuver (applying shoulder pressure to the fetus to decreases the bisacromial diameter) | ||
Revision as of 21:06, 2 August 2015
Background
Occurs in 0.2 to 3 percent of all births
Clinical Presentation
A clinical diagnosis. It should be suspected when the fetal head retracts into the perineum (ie, turtle sign) after expulsion due to reverse traction from the shoulders being impacted at the pelvic inlet. The diagnosis is made when the routine practice of gentle, downward traction of the fetal head fails to accomplish delivery of the anterior shoulder.
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
- All fours maneuver - move pt to her hands and knees, 82 cases of shoulder dystocia, ~80% delivered without additional maneuvers[1]
HELPER
- H call for help
- E episiotomy (or episioproctotomy) to increase the anteroposterior 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)
See Also
References
- ↑ Bruner JP et al. All-fours maneuver for reducing shoulder dystocia during labor. J Reprod Med. 1998 May;43(5):439-43.