Tuesday, 27 September 2016

Video: Shoulder Dystocia

Shoulder dystocia is an obstetric complication of cephalic (head) vaginal deliveries during which the foetal shoulders do not deliver after the head has emerged from the mother’s introitus.

It occurs when one or both shoulders becomes impacted against the bones of the maternal pelvis, as shown in the video.

Proper management of shoulder dystocia is important to avoid untoward outcomes.

Some foetal manoeuvres include cleidotomy (surgical division of the clavicles or collar bone); Zavanelli manoeuvre ; Rubins manoeuvre.

Maternal manoeuvres include Suprapubic pressure; Sims manoeuvre (lateral decubitus); McRoberts manoeuvre;Gaskins manoeuvre (all fours).

Brachial plexus injury to the newborn is the most common complication of shoulder dystocia. Most of these injuries resolve before discharge from the hospital. However, some last longer and take weeks or up to 18 months to resolve and a few can be permanent, with varying levels of limited motion depending on the nature and extent of the injury.

Another complication is Postpartum haemorrhage (PPH) which can result from uterine atony caused by either overdistention from foetal macrosomia or dysfunctional contractility caused by mechanical obstruction.

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