list RF for shoulders
AMA, BMI>35, GDM, prev shoulders, macrosomia, precip/prolonged second stage, epidural block
list signs of shoulders
turtling, failure of fetal head restitution, head bobbing
describe HELPERR acronym
H: help, 7 mns to deliver
E: evaluate for epis, consider all 4s
L: legs, McRObert’s manoeuvre, increases pubic symphysis to sacrum diameter by flattening sacrum and tilting pubic bone upwards
P: pressure, suprapubic pressure on post aspect of ant shoulder, attempt to dislodge shoulder from pubic bone by reducing fetal shoulder diameter
E: enter internal manoeuvres, Rubin’s II= internal pressure on post aspect of ant shoulder attempt to dislodge under pubic bone, Woodscrew= add second hand to apply pressure to ant aspect of post shoulder, Reverse woodscrew= ant aspect of ant shoulder and post aspect of post shoulder pressure to attempt to dislodge other direction
R: remove posterior arm to reduce baby diameter and dislodge
R: roll woman on to all 4s, allow gravity to assist w dislodging and increase pelvic diameter by allowing sacrum to open
describe last resort measures for shoulder dystocia
deliberate # of the clavicle: reduce fetal diameter
symphysiotomy: divide fibrous cartilage of symph pubis and free shoulder- high mat morbidity rate
cephalic replacement: pressure on fetal head to return to birth canal with direct transfer to OT
GA: muscle relaxant may allow for birth
what situations may follow a shoulders that also need management and how would you prep for these?
PPH: senior staff and OB aware and present, active management third stage
fetal hypoxia/neonatal resus: paeds and experienced staff aware and present
head entrapment: theatres aware
