medical notes

Apr 16th, 2015
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SHOULDER DYSTOCIALearning objectivesBy the end of this session the learner should beable to; Identify mothers at increased risk of developingshoulder dystocia Recognize and make a diagnosis of shoulderdystocia Take appropriate steps to deliver a mother withshoulder dystocia Identify maternal and fetal complicationsfollowing shoulder dystociaShoulder dystociaBasics Dystocia; difficult passage Shoulder dystocia; impaction of the fetalshoulder behind the pubic symphysis Incidence 0.2-3% of vaginal births,Shoulder dystociaPredisposedCannot be accurately predicted or prevented Fetal macrosomia Maternal obesity Previous history of big/large baby or shoulderdystocia Diabetes in pregnancy Postdates Fetal anomalies Increased maternal ageShoulder dystociaDiagnosis Fetal head delivered but remains tightlyapplied to the vulva Chin retracts and depresses the perineum(Turtle sign) Traction on the head fails to deliver theshoulderShoulder dystociaMAPS MNEMONIC Mc Roberts Anterior shoulder Posterior shoulder SalvageShoulder dystociaActions Call for help McRoberts Position knees as far as possible up to the chest andabduct and rotate legs outwards Suprapubic pressure using the heel of the hands Episiotomy to reduce soft tissue obstruction andmake room for other manoeuvresShoulder dystociaActions Rotational Maneuvers; Apply pressure

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