[Maternity] Shoulder Dystocia

**During the second stage of labor. After birth of the fetal head, the nurse notes retraction of the head toward the maternal perineum.산모의 회음부를 향해 얼굴이 수축됨. **

 

difficult birth.

1. Obstetrical emergency

-Fetal head emerges but the anterior shoulder remains wedged behind the maternal symphysis pubis 

 

2. Clinical Features

i) Protracted labor

ii) Slow fetal descent

iii) Fetal head retraction back toward the perineum (ie, turtle sign)

 

3. Risk Factor

i) Some patients have no risk factors at all

ii) Fetal macrosomia (8lb 13 oz [4000g])

iii) Gestational diabetes mellitus

iv) Postterm pregnancy (> 42 weeks gestation)

v) Meteral obesity

vi) Excessive pregnancy weight gain

vii) Protracted labor : unchanged fetal station for several hours, prolonged second stage of labor

 

4. NRS Action

i) Goal: facilitate rapid vaginal birth

ii) Call for assistance

iii) Lower the head of the bed

iv) Assist in maneuvers (eg. McRoberts maneuver, suprapubic pressure)

• McRoberts maneuver: Extremely common. Legs flexed onto abdomen causes rotation of pelvis, alignment of sacrum & opening of birth canal
• Suprapubic pressure: Applied to fetal anterior shoulder . b/c shoulder impacted behind pubic symphysis. "Press down on the symphysis pubis"- fundal pressure랑은 완전히 다름. 

v) Document the exact time of events

vi) call out time reminders. (ex. "it's been one minute!", "it's been two minute!")-> more time that passes, the greater the last of the complication the both mom and baby. 

 

5. mother Complications

i) post partum hemorrhage

ii) perineal lacerations

fetal complications

i)asphyxia & death

ii) hypoxic-ischemic brain injury (eg. cerebral palsy)

iii) Brachial plexus injuries (shoulder/arm nerve injury causing weakness)

iv) Fractured clavicle or humerus