Shoulder_Dystocia 2024.pdf

ReadacOG McRoberl (To delivery of head) AGA: Appropriate for gestational age Shoulder dystocia is more common in babies with a higher birth weight. Therefore, if a fetus is estimated to have a high weight, it could indicate a higher risk of shoulder dystocia occurring during delivery. However, it's...

ReadacOG McRoberl (To delivery of head) AGA: Appropriate for gestational age Shoulder dystocia is more common in babies with a higher birth weight. Therefore, if a fetus is estimated to have a high weight, it could indicate a higher risk of shoulder dystocia occurring during delivery. However, it's important to note that the prediction is not always accurate and shoulder dystocia can occur even in babies with normal weight. 50% What is the primary role of estimating fetal weight at term in the context of shoulder dystocia? A) To determine the necessity of a cesarean section B) To predict the likelihood of shoulder dystocia accurately C) As a screening tool to assess the risk of shoulder dystocia D) To decide on the type of anesthesia to be used during delivery e According to the information provided, which maternal injury is NOT associated with aggressive hyperflexion of the maternal legs during shoulder dystocia? A) Maternal symphyseal separation B) Lateral femoral cutaneous neuropathy C) Coccyx fracture D) Perineal tears Non-diabetic mom 5,000g Diabetic mom 4,500g When c-section is recommended ACOG does not recommend labor induction or cesarean delivery solely for suspected macrosomia with estimated fetal weights less than 5000 grams in women without diabetes and less than 4500 grams in women with diabetes. The reasoning is that current methods of estimating fetal weight, particularly late in pregnancy, are imprecise. Also, the potential benefits of such interventions do not outweigh the risks, such as potential for unnecessary cesarean deliveries and related complications.. What is the significance of the "turtle sign" during childbirth, as mentioned in the context of shoulder dystocia? A) It indicates a breech presentation of the baby. B) It suggests the presence of shoulder dystocia. C) It signifies a nuchal cord complication. D) It represents the fetal head descending into the birth canal. Suggestive but not a definitive sign Should be attempted rst In cases where the McRoberts maneuver and supra pubic pressure are unsuccessful, delivery of the posterior arm can be considered as the next maneuver to manage shoulder dystocia all–fours maneuver in which the woman is placed on her hands and knees and delivery is e ected by gentle downward traction on the posterior shoulder (the shoulder against the maternal sacrum) or upward traction on the anterior shoulder, may be useful. Which maneuver involves the mother assuming a hands-and-knees position to facilitate delivery and is recommended as a preventive measure for shoulder dystocia? A) McRoberts Maneuver B) Rubin Maneuver C) Gaskin Maneuver D) Zavenelli Procedure With the Rubin maneuver, the health care provider places a hand in the vagina and on the back surface of the posterior fetal shoulder, then rotates it anteriorly towards the fetal face With the Woods Screw maneuver, the health care provider instead rotates the fetus by exerting pressure on the anterior, clavicular surface of the posterior shoulder to turn the fetus until the anterior shoulder emerges from behind the maternal symphysis. “Not shown to be helpful it’s a bony problem” Pushing the baby's head back into the birth canal followed by an emergency cesarean section Cutting the symphysis pubis Push back on clavicle not down. Pushing down will puncture the lung During a complicated delivery, all primary and ancillary maneuvers to manage shoulder dystocia have failed. As a midwife, you decide to proceed with the Zavanelli maneuver. What does this procedure primarily involve? A) Performing an emergency cesarean section without repositioning the baby's head. B) Repositioning the baby's shoulders without performing a cesarean section. C) Pushing the baby's head back into the birth canal followed by an emergency cesarean section. D) Performing a cesarean section while the baby's head is still delivered. A pregnant woman is experiencing a prolonged obstructed labor and a cesarean section is not possible due to certain circumstances. As a midwife, you decide to perform a symphysiotomy. What does this procedure involve? A) Surgically widening the pelvis by cutting the symphysis pubis. B) Performing an episiotomy to enlarge the vaginal opening. C) Manually turning the baby inside the womb. D) Cutting the perineal body to facilitate delivery. Although there are a number of known risk factors, shoulder dystocia cannot be accurately predicted or prevented. Clinicians should be aware of the risk factors for shoulder dystocia in order to anticipate those deliveries at high risk and should be prepared to address this complication in all deliveries. Elective cesarean delivery should be considered for women without diabetes who are carrying fetuses with suspected macrosomia with an estimated fetal weight of at least 5,000 g and for women with diabetes whose fetuses are estimated to weigh at least 4,500 g. When shoulder dystocia is suspected, the McRoberts maneuver should be attempted rst because it is a simple, logical, and e ective technique. Contemporaneous documentation of the management of shoulder dystocia is recommended to record signi cant facts, ndings, and observations about the shoulder dystocia event and its sequelae. Simulation exercises and shoulder dystocia protocols are recommended to improve team communication and maneuver use because this may reduce the incidence of brachial plexus palsy associated with shoulder dystocia. The following recommendation is based primarily on consensus and expert opinion (Level C): In cases where the McRoberts maneuver and suprapubic pressure are unsuccessful, delivery of the posterior arm can be considered as the next maneuver to manage shoulder dystocia