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Mediquest - September '07 Edition |
SHOULDER DYSTOCIA - DR.ASHA RAVINDRAN, MBBS, DGO.
• Difficulty experienced in the delivery of the shoulder following the birth of the baby's head is a serious complication.
• It is usually caused by baby's anterior shoulder getting caught behind the symphysis pubis.
• Sometimes it can occur when the baby's posterior shoulder gets caught on the mother's sacrum, but it is less common.
INCIDENCE : 0.5 – 1.5 % of all deliveries.
CONTRIBUTING FACTORS
• Maternal diabetes leading to foetal macrosomia.
• Post term pregnancy.
• Prolonged labour.
• Instrumental deliveries.
• Anencephalic foetuses especially post term.
• Constriction ring. |
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RECOGNITION
The two main signs that give rise to suspicion that shoulder dystocia is present are :-
• The baby's body does not emerge with standard moderate traction and maternal pushing after delivery of the head.
• THE TURTLE SIGN
The foetal head retracts against the maternal perineum after it emerges from the vagina. |
The baby's cheeks bulge out (resembling a turtle pulling its head back into its shell). The retraction of foetal head is caused by the baby's anterior shoulder being caught on the back of the maternal pubic bone preventing delivery of the rest of the body.
MANAGEMENT
• Call for help – paediatrician, anaesthetist, assistant etc.
• Generous episiotomy to be given.
• Clearing the nasopharynx of the baby.
• Suprapubic pressure given by an assistant and normal downward traction to be given on foetal head.
• Mc Roberts maneuver
Sharply flexing the mother's thighs upon her abdomen results in sacral straightening in relative to lumbar vertebra with accompanying cephalic rotation of symphysis pubis and reduces the angle of pelvic inclination.
If all these fail, try :-
• Woods maneuver (Wood's corkscrew maneuver):- progressive rotation of the posterior shoulder to 180` in a corkscrew manner releases the impacted anterior shoulder.
• Delivery of the posterior shoulder: - consists of carefully sweeping the posterior arm of the foetus across the chest wall followed by delivery of the arm. The shoulder girdle is then rotated into one of the oblique diameters of the pelvis and subsequent delivery of anterior shoulder completed.
