Shoulder dystocia: Difference between revisions
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==Background== | ==Background== | ||
*Occurs in 0.2 to 3 percent of all births | *Occurs in 0.2 to 3 percent of all births | ||
*Due to reverse traction from the shoulders being impacted at the pelvic inlet | |||
===Risk Factors=== | ===Risk Factors=== | ||
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==Clinical Presentation== | ==Clinical Presentation== | ||
*Routine practice of gentle, downward traction of the fetal head fails to accomplish delivery of the anterior shoulder | |||
*Fetal head retracts into the perineum (ie, turtle sign) after expulsion | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Diagnosis== | ==Diagnosis== | ||
*Clinical diagnosis | |||
==Treatment== | ==Treatment== | ||
Revision as of 04:10, 3 August 2015
Background
- Occurs in 0.2 to 3 percent of all births
- Due to reverse traction from the shoulders being impacted at the pelvic inlet
Risk Factors
- Pre-labor
- Previous shoulder dystocia
- Macrosomia
- DM
- Maternal BMI > 30
- Induction of labor
- Intrapartum
- Prolonged first or second stage
- Oxytocin augmentation
- Assisted vaginal delivery
Clinical Presentation
- Routine practice of gentle, downward traction of the fetal head fails to accomplish delivery of the anterior shoulder
- Fetal head retracts into the perineum (ie, turtle sign) after expulsion
Differential Diagnosis
- Emergent delivery
- Umbilical cord prolapse
- Breech delivery
- Shoulder dystocia
- Perimortem cesarean delivery
Diagnosis
- Clinical 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 anteroposterior diameter of passage
- L Legs flex (McRoberts maneuver)
- P Pressure - rocking suprapubic pressure and Rubin’s maneuver (applying shoulder pressure to the fetus to decreases the bisacromial diameter) - try for 30 seconds
- E Enter the vagina and attempt Wood’s corkscrew maneuver by pushing the most accessible shoulder toward the chest to corkscrew the shoulders through - maintain rocking suprapubic pressure at the same time
- 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
- Repeat maneuvers on all fours - move pt to her hands and knees, 82 cases of shoulder dystocia, ~80% delivered without additional maneuvers[1]
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.