Shoulder Dystocia Management Guideline Review

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What is the purpose of the guideline discussed?

To describe in detail the practical manoeuvres for managing shoulder dystocia

To highlight the importance of prenatal care for gestational diabetes mellitus

To provide guidance on management of shoulder dystocia (correct)

To review evidence on primary prevention of fetal macrosomia

Where can detailed practical manoeuvres for managing shoulder dystocia be found?

In the RCOG guideline itself

In research articles from the OVID database

In standard textbooks and course manuals like PROMPT (correct)

In guidelines from the National Guidelines Clearing House

Which databases were included in the search for evidence during the revision of this RCOG guideline?

Google Scholar and Scopus

Medline and Cochrane Database of Systematic Reviews (correct)

Embase and Web of Science

PubMed and JSTOR

What was the time frame for articles included in the search for evidence?

Between January 1980 and May 2011 Signup and view all the answers

Which of the following courses is NOT mentioned as a potential source for detailed practical manoeuvres?

CEMACH (Confidential Enquiry into Maternal and Child Health) Signup and view all the answers

What methodology was followed for producing the RCOG Green-top Guidelines?

Standard methodology for producing RCOG guidelines Signup and view all the answers

What language restriction was applied during the search for evidence?

Restricted to English language only Signup and view all the answers

What percentage of shoulder dystocia cases resulting in infant morbidity were predicted by conventional risk factors?

16% Signup and view all the answers

Why is fetal size not a good predictor for shoulder dystocia?

It is difficult to determine accurately and not all infants with a birth weight of ≥4500g develop shoulder dystocia. Signup and view all the answers

What is the increased risk of shoulder dystocia for infants of diabetic mothers compared to infants of non-diabetic mothers?

Two-fold increased risk Signup and view all the answers

Which variables were reported as the best combination to identify neonatal injury associated with shoulder dystocia in the predictive model study?

Maternal height and weight, gestational age and parity, and birth weight Signup and view all the answers

What percentage of births complicated by shoulder dystocia occur with infants weighing less than 4000g?

48% Signup and view all the answers

Why do conventional risk factors have a low positive predictive value for shoulder dystocia?

They only predict a small percentage of shoulder dystocia cases resulting in morbidity. Signup and view all the answers

What makes fetal size a poor predictor for shoulder dystocia?

'Large majority' of infants with a birth weight ≥4500g develop shoulder dystocia Signup and view all the answers

What is a method suggested to facilitate delivery in cases of shoulder dystocia?

Rotation into an oblique diameter Signup and view all the answers

Who originally described the internal rotational manoeuvres mentioned in the text?

Woods Signup and view all the answers

What additional benefit does pressure on the posterior aspect of the posterior shoulder provide?

Reducing the shoulder diameter by adducting the shoulders Signup and view all the answers

If pressure on the posterior shoulder is unsuccessful, what should be attempted next?

Applying pressure on the anterior shoulder Signup and view all the answers

What does delivering the posterior arm help reduce in cases of shoulder dystocia?

Shoulder diameter Signup and view all the answers

What is a suggested method to achieve rotation during delivery?

Pressing on the anterior or posterior aspect of the posterior shoulder Signup and view all the answers

In cases where pressure on the posterior shoulder fails, what role does applying pressure on the anterior shoulder play?

To adduct and rotate the shoulders into an oblique diameter Signup and view all the answers

What is the reported incidence of humeral fractures associated with delivery of the posterior arm?

2% to 12% Signup and view all the answers

Why might neonatal trauma occur during delivery of the posterior arm?

Because of the refractory nature of the case Signup and view all the answers

What is recommended as a basis for healthcare professionals to make decisions regarding delivery techniques?

Training, clinical experience, and circumstances Signup and view all the answers

Which technique has been described with an 83% success rate in one case series?

'All-fours' position Signup and view all the answers

What does the text recommend as a factor to guide healthcare professionals in deciding whether to use the 'all-fours' technique?

Individual circumstances Signup and view all the answers

Which method was associated with reductions in both BPI and humeral fractures compared to delivery of the posterior arm?

'Rotational manoeuvres' Signup and view all the answers

Why is there a lack of randomised comparative studies comparing delivery techniques mentioned in the text?

Inadequate evidence availability Signup and view all the answers

Who were the peer reviewers mentioned in the text?

Dr HM Cameron FRCOG and Mr D I Fraser FRCOG Signup and view all the answers

What is the responsibility of the guidelines committee of the RCOG as mentioned in the text?

Producing guidelines as an educational aid to good clinical practice Signup and view all the answers

What should be considered by obstetricians and gynaecologists when using the RCOG Guidelines?

Published evidence Signup and view all the answers

Who were the conflicts of interest declared by, as stated in the text?

None declared Signup and view all the answers

When will the guidelines review process commence according to the text?

2015 Signup and view all the answers

What distinguishes RCOG Guidelines from protocols or guidelines issued by employers?

They are not intended to be prescriptive directions Signup and view all the answers

Who are ultimately responsible for making judgments regarding clinical procedures or treatment plans as per the text?

Patients Signup and view all the answers

'RCOG Guidelines are unlike protocols or guidelines issued by employers,' - why is this statement true?

'Employers' guidelines are intended to be prescriptive directions. Signup and view all the answers

'The Royal College of Obstetricians and Gynaecologists produces guidelines as an educational aid to good clinical practice.' - What is the primary purpose of these guidelines?

'To offer educational support for healthcare professionals.' Signup and view all the answers

'The final version is the responsibility of the guidelines committee of the RCOG.' - What does this statement imply?

'The guidelines committee takes ownership of the final content.' Signup and view all the answers

What is the purpose of cleidotomy in managing shoulder dystocia?

Bending the clavicle with a finger Signup and view all the answers

In cases resistant to standard measures, what is the purpose of symphysiotomy?

Dividing the anterior fibers of symphyseal ligament Signup and view all the answers

What is the primary function of the Zavanelli manoeuvre in cases of shoulder dystocia?

Returning the fetal head to the maternal pelvis Signup and view all the answers

Why might cleidotomy be considered in cases of shoulder dystocia?

To bend the fetal clavicle Signup and view all the answers

'When may cleidotomy be needed in managing shoulder dystocia?'

When internal rotational manoeuvres fail Signup and view all the answers

What is a potential risk associated with the Zavanelli manoeuvre for shoulder dystocia as discussed in the text?

Increased risk of irreversible hypoxia-acidosis in fetuses Signup and view all the answers

Why should practitioners exercise caution when considering symphysiotomy as a procedure for shoulder dystocia?

It leads to poor neonatal outcomes Signup and view all the answers

What is a potential downside of using a posterior axillary sling for shoulder dystocia management based on the text?

Limited available data on its efficacy Signup and view all the answers

What should birth attendants be watchful for after managing shoulder dystocia?

Possibility of postpartum haemorrhage and severe perineal tears Signup and view all the answers

Why is the safety of the Zavanelli manoeuvre in shoulder dystocia cases highlighted as unknown in the text?

Maternal safety data are lacking due to potential risks involved Signup and view all the answers

What should be applied to the fetal head to assess whether the shoulders have been released during a shoulder dystocia situation?

Routine traction Signup and view all the answers

In the management of shoulder dystocia, which technique can be employed together with the McRoberts’ manoeuvre to improve success rates?

Suprapubic pressure Signup and view all the answers

During the application of suprapubic pressure in shoulder dystocia management, what does it aim to reduce?

Fetal bisacromial diameter Signup and view all the answers

What is the ideal direction for applying suprapubic pressure in a shoulder dystocia situation?

Downward and lateral Signup and view all the answers

What is recommended to free the shoulder to slip underneath the symphysis pubis during shoulder dystocia management?

Routine axial traction Signup and view all the answers

What is the main reason to avoid downward traction on the fetal head during delivery?

It causes nerve avulsion Signup and view all the answers

What type of traction should be avoided to prevent nerve avulsion according to cadaver studies?

Downward traction Signup and view all the answers

What intervention should be performed first in the management of shoulder dystocia?

McRoberts manoeuvre Signup and view all the answers

Why is the McRoberts manoeuvre recommended as a first step in managing shoulder dystocia?

It is a simple and rapid intervention Signup and view all the answers

What type of traction should be avoided during delivery to prevent obstetric brachial plexus injury?

Downward traction Signup and view all the answers

What should be discouraged during the management of shoulder dystocia?

Maternal pushing Signup and view all the answers

Which maneuver involves flexion and abduction of the maternal hips?

McRoberts’ manoeuvre Signup and view all the answers

Which intervention is reported to have success rates as high as 90% in managing shoulder dystocia?

McRoberts’ manoeuvre Signup and view all the answers

What is associated with a high neonatal complication rate and may result in uterine rupture during the management of shoulder dystocia?

Fundal pressure Signup and view all the answers

Which maneuver increases the relative anterior-posterior diameter of the pelvis?

McRoberts’ manoeuvre Signup and view all the answers

What is the purpose of using suprapubic pressure in conjunction with the McRoberts’ manoeuvre?

To improve the effectiveness of the manoeuvre Signup and view all the answers

According to the CESDI report mentioned, what proportion of babies that died did so within five minutes of the head being delivered?

47% Signup and view all the answers

What did the group from Hong Kong find regarding the rate of hypoxic ischaemic injury when the head-to-body delivery time was less than five minutes?

Decreased rate of hypoxic ischaemic injury Signup and view all the answers

Why is managing shoulder dystocia as efficiently as possible important?

To avoid unnecessary trauma Signup and view all the answers

What has been associated with improved perinatal outcomes when managing shoulder dystocia?

Following the RCOG algorithm Signup and view all the answers

Under what circumstances should an episiotomy be considered in cases of shoulder dystocia?

When there is difficulty gaining internal vaginal access with the healthcare professional's hand Signup and view all the answers

What is the purpose of cleidotomy in managing shoulder dystocia?

To alleviate the bony obstruction of the shoulder Signup and view all the answers

When may symphysiotomy be considered in cases resistant to standard measures for shoulder dystocia?

When all other manoeuvres have failed Signup and view all the answers

What is the primary function of cleidotomy in cases of shoulder dystocia?

To relieve the bony obstruction of the shoulder Signup and view all the answers

In what situation should an episiotomy NOT be considered in cases of shoulder dystocia?

When there is bony obstruction of the shoulder Signup and view all the answers

What is the main purpose of cleidotomy in managing shoulder dystocia?

To facilitate delivery by breaking the clavicle Signup and view all the answers

When is cleidotomy typically considered in managing shoulder dystocia?

When other delivery techniques have failed Signup and view all the answers

What complications might lead to the consideration of cleidotomy in shoulder dystocia?

Permanent brachial plexus injury Signup and view all the answers

In what circumstances would cleidotomy be needed in managing shoulder dystocia?

When the baby's head is entrapped after delivery of the body Signup and view all the answers

What effect does cleidotomy have on facilitating delivery in shoulder dystocia?

It allows for easier passage of the baby's shoulder through the birth canal Signup and view all the answers

Why might cleidotomy be considered as a last resort in managing shoulder dystocia?

Given its potential to cause permanent injury to the infant Signup and view all the answers

What consequences can occur if cleidotomy is not performed when indicated for shoulder dystocia?

Risk of permanent brachial plexus injury to the infant Signup and view all the answers

What is a potential complication that might arise from not performing cleidotomy during shoulder dystocia management?

'Erb's palsy' in the newborn Signup and view all the answers

What may cleidotomy help prevent during shoulder dystocia management?

Permanent nerve damage to the newborn Signup and view all the answers

How does cleidotomy aid in managing shoulder dystocia?

By allowing for easier delivery of the baby's shoulders Signup and view all the answers

What is a potential complication that might arise from not performing cleidotomy during shoulder dystocia management?

Fetal brachial plexus injury Signup and view all the answers

What is recommended to free the shoulder to slip underneath the symphysis pubis during shoulder dystocia management?

Digital maneuvers Signup and view all the answers

What distinguishes RCOG Guidelines from protocols or guidelines issued by employers?

Directives for patient care Signup and view all the answers

Which maneuver increases the relative anterior-posterior diameter of the pelvis?

Symphysiotomy Signup and view all the answers

What type of traction should be avoided during delivery to prevent obstetric brachial plexus injury?

Direct traction on the fetal head Signup and view all the answers

What is a significant concern related to applying the Zavanelli manoeuvre in cases of shoulder dystocia?

Unknown maternal safety of the procedure Signup and view all the answers

Why is symphysiotomy considered a potentially useful procedure for shoulder dystocia in both developing and developed countries?

Limited data availability on its effectiveness Signup and view all the answers

What should be taken into account when considering the use of symphysiotomy in shoulder dystocia management?

Serious maternal and neonatal complications Signup and view all the answers

Why is there caution advised when using symphysiotomy for shoulder dystocia management?

Significant risk of serious maternal morbidity and poor neonatal outcome Signup and view all the answers

What should be given serious consideration when practitioners are not trained in symphysiotomy technique?

The risks associated with symphysiotomy Signup and view all the answers

In cases resistant to standard measures, which method involves dividing the anterior fibres of the symphyseal ligament?

Zavanelli manoeuvre Signup and view all the answers

What is the purpose of symphysiotomy in managing shoulder dystocia?

Dividing the symphyseal ligament Signup and view all the answers

What might lead to the consideration of cleidotomy during shoulder dystocia management?

Failure of first- and second-line manoeuvres Signup and view all the answers

Which method involves surgical division of the clavicle or bending it with a finger?

Cleidotomy Signup and view all the answers

When should symphysiotomy be considered during shoulder dystocia management?

For cases resistant to standard measures Signup and view all the answers

What is the primary purpose of performing a symphysiotomy in cases resistant to standard measures for shoulder dystocia?

To increase the relative anterior-posterior diameter of the pelvis Signup and view all the answers

Why is downward traction on the fetal head discouraged during delivery for shoulder dystocia?

It can obstruct the shoulder from sliding underneath the symphysis pubis Signup and view all the answers

What distinguishes a symphysiotomy from other management techniques for shoulder dystocia?

It aims to reduce the fetal bisacromial diameter Signup and view all the answers

When might an episiotomy NOT be considered as a suitable option during shoulder dystocia management?

When performing a symphysiotomy Signup and view all the answers

What is a potential complication that may arise from delaying or avoiding symphysiotomy in managing shoulder dystocia?

Failure to release the anterior shoulder Signup and view all the answers

What is the primary reason for considering an episiotomy in cases of shoulder dystocia?

To facilitate internal vaginal manoeuvres Signup and view all the answers

What is the aim of using the 'all-fours' position or internal manoeuvres if simple techniques fail in managing shoulder dystocia?

To gain access for internal manoeuvres into the sacral hollow Signup and view all the answers

When should an episiotomy be considered in cases of shoulder dystocia?

If routine traction is unsuccessful Signup and view all the answers

What should be done if the McRoberts manoeuvre and suprapubic pressure are ineffective in managing shoulder dystocia?

Consider the 'all-fours' position Signup and view all the answers

What is the most spacious part of the pelvis that should be accessed for internal manoeuvres in cases of shoulder dystocia?

Sacral hollow Signup and view all the answers

What is the primary reason for avoiding unnecessary episiotomies in cases of shoulder dystocia?

To reduce neonatal trauma Signup and view all the answers

In cases resistant to standard measures for shoulder dystocia, what is the main consideration for performing a symphysiotomy?

To decrease the risk of infant morbidity Signup and view all the answers

What key advantage does the RCOG algorithm offer in managing shoulder dystocia?

Improved perinatal outcomes Signup and view all the answers

Why is immediate help recommended when managing shoulder dystocia according to the text?

To avoid hypoxic ischaemic injury Signup and view all the answers

What is the primary reason for using suprapubic pressure alongside the McRoberts manoeuvre?

To enhance the effectiveness of the manoeuvre Signup and view all the answers

What is a common indication for symphysiotomy in the management of shoulder dystocia?

Fetal macrosomia Signup and view all the answers

When might symphysiotomy be deemed necessary in managing shoulder dystocia?

When pressure on the posterior shoulder fails Signup and view all the answers

What is a potential concern associated with symphysiotomy in the context of shoulder dystocia?

Risk of uterine rupture Signup and view all the answers

In which scenario might symphysiotomy be performed during the management of shoulder dystocia?

As a last resort in freeing the impacted shoulder Signup and view all the answers

What is a likely consequence if symphysiotomy is not performed when indicated for shoulder dystocia?

Risk of permanent brachial plexus injury Signup and view all the answers

What is a potential complication of symphysiotomy that should be considered when managing shoulder dystocia?

Risk of uterine rupture Signup and view all the answers

Why should practitioners exercise caution when considering symphysiotomy as a procedure for shoulder dystocia?

It carries the risk of significant maternal morbidity Signup and view all the answers

If all other measures fail in managing shoulder dystocia, when may symphysiotomy be considered as a last resort?

In cases resistant to standard measures Signup and view all the answers

Which of the following statements about symphysiotomy in managing shoulder dystocia is accurate?

Symphysiotomy is rarely necessary in modern obstetric practice Signup and view all the answers

What role does symphysiotomy play in the context of managing shoulder dystocia effectively?

Secondary intervention after McRoberts' maneuver Signup and view all the answers

What is the main reason symphysiotomy is considered a potentially useful procedure for shoulder dystocia?

To assist with fetal delivery in cases where other measures fail Signup and view all the answers

What potential complication might lead to the consideration of symphysiotomy in shoulder dystocia?

Fetal hypoxic brain damage Signup and view all the answers

Why is there caution advised when considering symphysiotomy for shoulder dystocia management?

Risk of irreversible neonatal injury Signup and view all the answers

What distinguishes symphysiotomy from other interventions for shoulder dystocia management?

Involves a surgical procedure on the maternal pelvis Signup and view all the answers

When may symphysiotomy be considered according to the text?

In cases where other measures have failed Signup and view all the answers

What is a potential risk associated with symphysiotomy for shoulder dystocia management?

Potential neonatal neurologic injury Signup and view all the answers

Under what circumstances should symphysiotomy be considered according to the text?

When standard measures are ineffective Signup and view all the answers

What does symphysiotomy aim to achieve when used in managing shoulder dystocia?

'Freeing' the shoulder to pass under the pubic bone Signup and view all the answers

Shoulder Dystocia Management Guideline Review

Podcast Beta

Questions and Answers

What is the purpose of the guideline discussed?

Where can detailed practical manoeuvres for managing shoulder dystocia be found?

Which databases were included in the search for evidence during the revision of this RCOG guideline?

What was the time frame for articles included in the search for evidence?

Which of the following courses is NOT mentioned as a potential source for detailed practical manoeuvres?

What methodology was followed for producing the RCOG Green-top Guidelines?

What language restriction was applied during the search for evidence?

What percentage of shoulder dystocia cases resulting in infant morbidity were predicted by conventional risk factors?

Why is fetal size not a good predictor for shoulder dystocia?

What is the increased risk of shoulder dystocia for infants of diabetic mothers compared to infants of non-diabetic mothers?

Which variables were reported as the best combination to identify neonatal injury associated with shoulder dystocia in the predictive model study?

What percentage of births complicated by shoulder dystocia occur with infants weighing less than 4000g?

Why do conventional risk factors have a low positive predictive value for shoulder dystocia?

What makes fetal size a poor predictor for shoulder dystocia?

What is a method suggested to facilitate delivery in cases of shoulder dystocia?

Who originally described the internal rotational manoeuvres mentioned in the text?

What additional benefit does pressure on the posterior aspect of the posterior shoulder provide?

If pressure on the posterior shoulder is unsuccessful, what should be attempted next?

What does delivering the posterior arm help reduce in cases of shoulder dystocia?

What is a suggested method to achieve rotation during delivery?

In cases where pressure on the posterior shoulder fails, what role does applying pressure on the anterior shoulder play?

What is the reported incidence of humeral fractures associated with delivery of the posterior arm?

Why might neonatal trauma occur during delivery of the posterior arm?

What is recommended as a basis for healthcare professionals to make decisions regarding delivery techniques?

Which technique has been described with an 83% success rate in one case series?

What does the text recommend as a factor to guide healthcare professionals in deciding whether to use the 'all-fours' technique?

Which method was associated with reductions in both BPI and humeral fractures compared to delivery of the posterior arm?

Why is there a lack of randomised comparative studies comparing delivery techniques mentioned in the text?

Who were the peer reviewers mentioned in the text?

What is the responsibility of the guidelines committee of the RCOG as mentioned in the text?

What should be considered by obstetricians and gynaecologists when using the RCOG Guidelines?

Who were the conflicts of interest declared by, as stated in the text?

When will the guidelines review process commence according to the text?

What distinguishes RCOG Guidelines from protocols or guidelines issued by employers?

Who are ultimately responsible for making judgments regarding clinical procedures or treatment plans as per the text?

'RCOG Guidelines are unlike protocols or guidelines issued by employers,' - why is this statement true?

'The Royal College of Obstetricians and Gynaecologists produces guidelines as an educational aid to good clinical practice.' - What is the primary purpose of these guidelines?

'The final version is the responsibility of the guidelines committee of the RCOG.' - What does this statement imply?

What is the purpose of cleidotomy in managing shoulder dystocia?

In cases resistant to standard measures, what is the purpose of symphysiotomy?

What is the primary function of the Zavanelli manoeuvre in cases of shoulder dystocia?

Why might cleidotomy be considered in cases of shoulder dystocia?

'When may cleidotomy be needed in managing shoulder dystocia?'

What is a potential risk associated with the Zavanelli manoeuvre for shoulder dystocia as discussed in the text?

Why should practitioners exercise caution when considering symphysiotomy as a procedure for shoulder dystocia?

What is a potential downside of using a posterior axillary sling for shoulder dystocia management based on the text?

What should birth attendants be watchful for after managing shoulder dystocia?

Why is the safety of the Zavanelli manoeuvre in shoulder dystocia cases highlighted as unknown in the text?

What should be applied to the fetal head to assess whether the shoulders have been released during a shoulder dystocia situation?

In the management of shoulder dystocia, which technique can be employed together with the McRoberts’ manoeuvre to improve success rates?

During the application of suprapubic pressure in shoulder dystocia management, what does it aim to reduce?

What is the ideal direction for applying suprapubic pressure in a shoulder dystocia situation?

What is recommended to free the shoulder to slip underneath the symphysis pubis during shoulder dystocia management?

What is the main reason to avoid downward traction on the fetal head during delivery?

What type of traction should be avoided to prevent nerve avulsion according to cadaver studies?

What intervention should be performed first in the management of shoulder dystocia?

Why is the McRoberts manoeuvre recommended as a first step in managing shoulder dystocia?

What type of traction should be avoided during delivery to prevent obstetric brachial plexus injury?

What should be discouraged during the management of shoulder dystocia?

Which maneuver involves flexion and abduction of the maternal hips?

Which intervention is reported to have success rates as high as 90% in managing shoulder dystocia?

What is associated with a high neonatal complication rate and may result in uterine rupture during the management of shoulder dystocia?

Which maneuver increases the relative anterior-posterior diameter of the pelvis?

What is the purpose of using suprapubic pressure in conjunction with the McRoberts’ manoeuvre?

According to the CESDI report mentioned, what proportion of babies that died did so within five minutes of the head being delivered?

What did the group from Hong Kong find regarding the rate of hypoxic ischaemic injury when the head-to-body delivery time was less than five minutes?

Why is managing shoulder dystocia as efficiently as possible important?

What has been associated with improved perinatal outcomes when managing shoulder dystocia?

Under what circumstances should an episiotomy be considered in cases of shoulder dystocia?

What is the purpose of cleidotomy in managing shoulder dystocia?

When may symphysiotomy be considered in cases resistant to standard measures for shoulder dystocia?

What is the primary function of cleidotomy in cases of shoulder dystocia?

In what situation should an episiotomy NOT be considered in cases of shoulder dystocia?

What is the main purpose of cleidotomy in managing shoulder dystocia?

When is cleidotomy typically considered in managing shoulder dystocia?

What complications might lead to the consideration of cleidotomy in shoulder dystocia?

In what circumstances would cleidotomy be needed in managing shoulder dystocia?