Shoulder Dystocia Management Guideline Review
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Questions and Answers

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?

    <p>Between January 1980 and May 2011</p> Signup and view all the answers

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

    <p>CEMACH (Confidential Enquiry into Maternal and Child Health)</p> Signup and view all the answers

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

    <p>Standard methodology for producing RCOG guidelines</p> Signup and view all the answers

    What language restriction was applied during the search for evidence?

    <p>Restricted to English language only</p> Signup and view all the answers

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

    <p>16%</p> Signup and view all the answers

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

    <p>It is difficult to determine accurately and not all infants with a birth weight of ≥4500g develop shoulder dystocia.</p> 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?

    <p>Two-fold increased risk</p> 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?

    <p>Maternal height and weight, gestational age and parity, and birth weight</p> Signup and view all the answers

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

    <p>48%</p> Signup and view all the answers

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

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

    What makes fetal size a poor predictor for shoulder dystocia?

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

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

    <p>Rotation into an oblique diameter</p> Signup and view all the answers

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

    <p>Woods</p> Signup and view all the answers

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

    <p>Reducing the shoulder diameter by adducting the shoulders</p> Signup and view all the answers

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

    <p>Applying pressure on the anterior shoulder</p> Signup and view all the answers

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

    <p>Shoulder diameter</p> Signup and view all the answers

    What is a suggested method to achieve rotation during delivery?

    <p>Pressing on the anterior or posterior aspect of the posterior shoulder</p> 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?

    <p>To adduct and rotate the shoulders into an oblique diameter</p> Signup and view all the answers

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

    <p>2% to 12%</p> Signup and view all the answers

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

    <p>Because of the refractory nature of the case</p> Signup and view all the answers

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

    <p>Training, clinical experience, and circumstances</p> Signup and view all the answers

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

    <p>'All-fours' position</p> 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?

    <p>Individual circumstances</p> 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?

    <p>'Rotational manoeuvres'</p> Signup and view all the answers

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

    <p>Inadequate evidence availability</p> Signup and view all the answers

    Who were the peer reviewers mentioned in the text?

    <p>Dr HM Cameron FRCOG and Mr D I Fraser FRCOG</p> Signup and view all the answers

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

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

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

    <p>Published evidence</p> Signup and view all the answers

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

    <p>None declared</p> Signup and view all the answers

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

    <p>2015</p> Signup and view all the answers

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

    <p>They are not intended to be prescriptive directions</p> Signup and view all the answers

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

    <p>Patients</p> Signup and view all the answers

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

    <p>'Employers' guidelines are intended to be prescriptive directions.</p> 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?

    <p>'To offer educational support for healthcare professionals.'</p> Signup and view all the answers

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

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

    What is the purpose of cleidotomy in managing shoulder dystocia?

    <p>Bending the clavicle with a finger</p> Signup and view all the answers

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

    <p>Dividing the anterior fibers of symphyseal ligament</p> Signup and view all the answers

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

    <p>Returning the fetal head to the maternal pelvis</p> Signup and view all the answers

    Why might cleidotomy be considered in cases of shoulder dystocia?

    <p>To bend the fetal clavicle</p> Signup and view all the answers

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

    <p>When internal rotational manoeuvres fail</p> Signup and view all the answers

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

    <p>Increased risk of irreversible hypoxia-acidosis in fetuses</p> Signup and view all the answers

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

    <p>It leads to poor neonatal outcomes</p> 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?

    <p>Limited available data on its efficacy</p> Signup and view all the answers

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

    <p>Possibility of postpartum haemorrhage and severe perineal tears</p> Signup and view all the answers

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

    <p>Maternal safety data are lacking due to potential risks involved</p> 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?

    <p>Routine traction</p> 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?

    <p>Suprapubic pressure</p> Signup and view all the answers

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

    <p>Fetal bisacromial diameter</p> Signup and view all the answers

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

    <p>Downward and lateral</p> Signup and view all the answers

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

    <p>Routine axial traction</p> Signup and view all the answers

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

    <p>It causes nerve avulsion</p> Signup and view all the answers

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

    <p>Downward traction</p> Signup and view all the answers

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

    <p>McRoberts manoeuvre</p> Signup and view all the answers

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

    <p>It is a simple and rapid intervention</p> Signup and view all the answers

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

    <p>Downward traction</p> Signup and view all the answers

    What should be discouraged during the management of shoulder dystocia?

    <p>Maternal pushing</p> Signup and view all the answers

    Which maneuver involves flexion and abduction of the maternal hips?

    <p>McRoberts’ manoeuvre</p> Signup and view all the answers

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

    <p>McRoberts’ manoeuvre</p> 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?

    <p>Fundal pressure</p> Signup and view all the answers

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

    <p>McRoberts’ manoeuvre</p> Signup and view all the answers

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

    <p>To improve the effectiveness of the manoeuvre</p> 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?

    <p>47%</p> 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?

    <p>Decreased rate of hypoxic ischaemic injury</p> Signup and view all the answers

    Why is managing shoulder dystocia as efficiently as possible important?

    <p>To avoid unnecessary trauma</p> Signup and view all the answers

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

    <p>Following the RCOG algorithm</p> Signup and view all the answers

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

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

    What is the purpose of cleidotomy in managing shoulder dystocia?

    <p>To alleviate the bony obstruction of the shoulder</p> Signup and view all the answers

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

    <p>When all other manoeuvres have failed</p> Signup and view all the answers

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

    <p>To relieve the bony obstruction of the shoulder</p> Signup and view all the answers

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

    <p>When there is bony obstruction of the shoulder</p> Signup and view all the answers

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

    <p>To facilitate delivery by breaking the clavicle</p> Signup and view all the answers

    When is cleidotomy typically considered in managing shoulder dystocia?

    <p>When other delivery techniques have failed</p> Signup and view all the answers

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

    <p>Permanent brachial plexus injury</p> Signup and view all the answers

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

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

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

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

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

    <p>Given its potential to cause permanent injury to the infant</p> Signup and view all the answers

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

    <p>Risk of permanent brachial plexus injury to the infant</p> Signup and view all the answers

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

    <p>'Erb's palsy' in the newborn</p> Signup and view all the answers

    What may cleidotomy help prevent during shoulder dystocia management?

    <p>Permanent nerve damage to the newborn</p> Signup and view all the answers

    How does cleidotomy aid in managing shoulder dystocia?

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

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

    <p>Fetal brachial plexus injury</p> Signup and view all the answers

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

    <p>Digital maneuvers</p> Signup and view all the answers

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

    <p>Directives for patient care</p> Signup and view all the answers

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

    <p>Symphysiotomy</p> Signup and view all the answers

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

    <p>Direct traction on the fetal head</p> Signup and view all the answers

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

    <p>Unknown maternal safety of the procedure</p> Signup and view all the answers

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

    <p>Limited data availability on its effectiveness</p> Signup and view all the answers

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

    <p>Serious maternal and neonatal complications</p> Signup and view all the answers

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

    <p>Significant risk of serious maternal morbidity and poor neonatal outcome</p> Signup and view all the answers

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

    <p>The risks associated with symphysiotomy</p> Signup and view all the answers

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

    <p>Zavanelli manoeuvre</p> Signup and view all the answers

    What is the purpose of symphysiotomy in managing shoulder dystocia?

    <p>Dividing the symphyseal ligament</p> Signup and view all the answers

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

    <p>Failure of first- and second-line manoeuvres</p> Signup and view all the answers

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

    <p>Cleidotomy</p> Signup and view all the answers

    When should symphysiotomy be considered during shoulder dystocia management?

    <p>For cases resistant to standard measures</p> Signup and view all the answers

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

    <p>To increase the relative anterior-posterior diameter of the pelvis</p> Signup and view all the answers

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

    <p>It can obstruct the shoulder from sliding underneath the symphysis pubis</p> Signup and view all the answers

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

    <p>It aims to reduce the fetal bisacromial diameter</p> Signup and view all the answers

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

    <p>When performing a symphysiotomy</p> Signup and view all the answers

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

    <p>Failure to release the anterior shoulder</p> Signup and view all the answers

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

    <p>To facilitate internal vaginal manoeuvres</p> 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?

    <p>To gain access for internal manoeuvres into the sacral hollow</p> Signup and view all the answers

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

    <p>If routine traction is unsuccessful</p> Signup and view all the answers

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

    <p>Consider the 'all-fours' position</p> 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?

    <p>Sacral hollow</p> Signup and view all the answers

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

    <p>To reduce neonatal trauma</p> Signup and view all the answers

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

    <p>To decrease the risk of infant morbidity</p> Signup and view all the answers

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

    <p>Improved perinatal outcomes</p> Signup and view all the answers

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

    <p>To avoid hypoxic ischaemic injury</p> Signup and view all the answers

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

    <p>To enhance the effectiveness of the manoeuvre</p> Signup and view all the answers

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

    <p>Fetal macrosomia</p> Signup and view all the answers

    When might symphysiotomy be deemed necessary in managing shoulder dystocia?

    <p>When pressure on the posterior shoulder fails</p> Signup and view all the answers

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

    <p>Risk of uterine rupture</p> Signup and view all the answers

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

    <p>As a last resort in freeing the impacted shoulder</p> Signup and view all the answers

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

    <p>Risk of permanent brachial plexus injury</p> Signup and view all the answers

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

    <p>Risk of uterine rupture</p> Signup and view all the answers

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

    <p>It carries the risk of significant maternal morbidity</p> Signup and view all the answers

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

    <p>In cases resistant to standard measures</p> Signup and view all the answers

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

    <p>Symphysiotomy is rarely necessary in modern obstetric practice</p> Signup and view all the answers

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

    <p>Secondary intervention after McRoberts' maneuver</p> Signup and view all the answers

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

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

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

    <p>Fetal hypoxic brain damage</p> Signup and view all the answers

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

    <p>Risk of irreversible neonatal injury</p> Signup and view all the answers

    What distinguishes symphysiotomy from other interventions for shoulder dystocia management?

    <p>Involves a surgical procedure on the maternal pelvis</p> Signup and view all the answers

    When may symphysiotomy be considered according to the text?

    <p>In cases where other measures have failed</p> Signup and view all the answers

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

    <p>Potential neonatal neurologic injury</p> Signup and view all the answers

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

    <p>When standard measures are ineffective</p> Signup and view all the answers

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

    <p>'Freeing' the shoulder to pass under the pubic bone</p> Signup and view all the answers

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