Distosia Bahu

Summary

This video discusses shoulder dystocia, a childbirth emergency where, after the baby's head is delivered, the shoulders become stuck, often due to factors like large birth weight or maternal obesity. The presentation covers the causes, risks, and potential complications for both mother and baby, such as uterine rupture, birth canal tears, and brachial plexus injuries. It emphasizes the importance of recognizing clinical signs, such as the 'Turtle sign,' and understanding the factors that increase the likelihood of shoulder dystocia. The session aims to educate midwives and healthcare providers on how to manage this critical obstetric condition.

Takeaways

• 😀 Shoulder dystocia is a condition where the anterior shoulder of the baby cannot pass through the birth canal after the head is delivered.
• 😀 Shoulder dystocia occurs in 1 to 2 per 1000 births, with higher rates among babies weighing over 4000 grams.
• 😀 Shoulder dystocia can lead to severe complications for both the mother and the baby, making it an obstetric emergency.
• 😀 For mothers, complications may include uterine rupture, cervical tears, and postpartum hemorrhage due to uterine atony.
• 😀 For babies, shoulder dystocia can cause brachial plexus injuries, fractures (humerus and clavicle), and even asphyxia, potentially leading to death if not managed well.
• 😀 Factors that increase the risk of shoulder dystocia include maternal obesity, diabetes during pregnancy, and post-term pregnancy.
• 😀 Babies born from mothers with previous shoulder dystocia are at higher risk for recurrence.
• 😀 The risk of shoulder dystocia increases with prolonged labor or difficult second stage of labor, as well as in multiple pregnancies.
• 😀 The 'Turtle Sign' is a clinical indicator of shoulder dystocia, where the baby’s head remains tightly attached to the vulva after delivery, indicating difficulty in delivering the shoulders.
• 😀 Early recognition of the signs of shoulder dystocia and prompt intervention are critical for better outcomes for both mother and baby.

Q & A

What is shoulder dystocia?

Shoulder dystocia is a condition where, after the head is delivered, the anterior shoulder fails to pass through the birth canal and becomes stuck beneath the pubic symphysis. This delay prevents the rest of the body from being delivered promptly.

What is the incidence of shoulder dystocia?

Shoulder dystocia occurs in 1 to 2 per 1000 births. The incidence increases to 16 per 1000 births when the baby’s weight is over 4000 grams.

What are the risks associated with shoulder dystocia for the mother?

For the mother, shoulder dystocia can lead to complications such as uterine rupture, cervical rupture, severe vaginal tearing (which may result in total rupture), and uterine atony postpartum, which can cause heavy bleeding.

What are the potential complications for the baby born with shoulder dystocia?

Complications for the baby include brachial plexus injury, fractures of the humerus or clavicle, asphyxia, and in severe cases, death if the complications are not addressed properly.

What causes brachial plexus injury in shoulder dystocia cases?

Brachial plexus injury occurs when excessive pulling during delivery, especially after the head is delivered, leads to trauma to the nerves that connect the spinal cord to the arms and hands, potentially causing arm paralysis.

What are the risk factors that increase the likelihood of shoulder dystocia during labor?

Risk factors include delivering a baby with a weight over 4000 grams (macrosomia), maternal obesity (BMI over 30), gestational diabetes, post-term pregnancies (over 42 weeks), and a history of previous shoulder dystocia.

How does the baby's size influence the occurrence of shoulder dystocia?

Larger babies, especially those with a birth weight over 4000 grams, are at a higher risk of shoulder dystocia because their shoulders may have difficulty fitting through the birth canal.

What clinical sign is characteristic of shoulder dystocia?

A key clinical sign is the 'Turtle Sign', where after the head is delivered, the baby’s head retracts back into the vaginal opening, resembling a turtle retreating into its shell. This indicates difficulty in delivering the shoulders.

Can shoulder dystocia occur without any risk factors?

Yes, shoulder dystocia can occur in 25 to 50% of cases without any identifiable risk factors. It can happen even in pregnancies with normal-sized babies, indicating the unpredictability of the condition.

How can healthcare providers manage shoulder dystocia during labor?

Healthcare providers must be aware of the warning signs and act quickly. Techniques like the McRoberts maneuver, suprapubic pressure, or the Zavanelli maneuver may be used to relieve the obstruction and ensure the safe delivery of the baby.