All are done in management of shoulder dystocia except:
Correct Answer: Fundal pressure
Description: Shoulder Dystocia:
The term shoulder dystocia is used to define a wide range of difficulties encountered in the delivery of the shoulders (A head to body delivery time exceeding 60 secs defines shoulder dystocia).
Risk factors: Shoulder dystocia can occur in all those conditions where fetus is too big or in case of mismanaged labour.
D-Maternal diabetes
O-Maternal obesity and fetal obesity, i.e macrosomia
P-Post-term pregnancy
A-Anencephaly, Fetal ascites
Management of shoulder dystocia:
Shoulder dystocia should be managed as quickly as possible as interval of time from delivery of head to delivery of body is of great importance as far as survival of baby is concerned. Management follows a sequence of steps together called as Shoulder Dystocia Drill.
First line measures:
Immediately after recognition of shoulder dystocia extra help should be called, in the form of midwifery assistance, an obstetrician, a paediatric resuscitation team and an anaesthetist.
Maternal pushing should be discouraged, as this may lead to further impaction of the shoulder, thereby exacerbating the situation.
Liberal episiotomy should be given to provide more space posteriorly.
Fundal pressure should not be employed. As it is associated with an unacceptably high neonatal complication rate and may result in uterine rupture.
Moderate suprapubic pressure can be applied by the assistant.
McRoberts’ manoeuvre is the single most effective intervention and should the first maneouvre to be performed. The
McRobert’s manoeuvre is flexion and abduction of the maternal hips, positioning the maternal thighs on her abdomen.
Second line measures: They should be done only, if first line measures fail:
Wood’s manoeuvre: It is progressively rotating the posterior shoulder by 180°. So that the impacted anterior shoulder is released.
Third line measures—They should be done only, if second line measures fail:
Cleidotomy: Fracturing the clavicle bone of the fetus
Symphiostomy: Dividing the pubic symphysis of the mother
Zavanelli manoeuvre: Replacing the head of the baby back into the pelvis followed by cesarean section.
Category:
Gynaecology & Obstetrics
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