young_doc
Forum Guru
Topics: 58
Posts: 737
|
Everywhere i look, it's Symphisiotomy that's recommended as an option in Shoulder Dystocia.
But Blueprints OB/GYN suggests Episiotomy instead (in fact, Blueprints makes no mention of doing a Symphisiotomy).
What's everyone else's take on this? I feel like Blueprints is wrong on this one.
___________________
First Aid is my Bible...
|
| vradojc1
Forum Elite
Topics: 21
Posts: 309
|
From Current OB&Gyn:
The McRoberts' maneuver should be used initially because it is simple and resolves shoulder dystocia in 42% of cases. The maternal legs are hyperflexed onto the maternal abdomen, resulting in flattening of the sacrum and cephalad rotation of the symphysis pubis. If the shoulders remain undelivered, suprapubic pressure is applied by an assistant to dislodge the anterior shoulder while gentle downward pressure on the head is applied. Suprapubic pressure and/or proctoepisiotomy increases success rates to between 54 and 58%. If these attempts are unsuccessful, the examiner can attempt to rotate the fetal shoulders into the oblique position by placing 2 fingers against the posterior shoulder and pushing it around toward the fetal chest (Rubin maneuver) or pushing the posterior shoulder around toward the fetal back (Wood's maneuver) in a corkscrew fashion.
If the maneuvers to this point fail, delivery of the posterior arm (Barnum maneuver) is indicated. The obstetrician's hand is inserted posteriorly into the hollow of the maternal sacrum, and the posterior arm of the fetus is identified. Gentle pressure by the examiner's forefinger on the fetal antecubital fossa will cause flexion of the arm. As the arm flexes across the chest, the forearm is gently grasped, and the hand and forearm are gently delivered from the birth canal. If not, the trunk can be rotated to bring the free arm anteriorly, resulting in delivery. Deliberate fracture of the clavicle also can be performed, preferably in a direction away from the fetal lungs. This action diminishes the size of the shoulder girdle and should facilitate delivery.
Finally, if all previous techniques fail, a Zavanelli maneuver can be performed in which the fetal head is replaced in anticipation of a cesarean delivery. A subcutaneous symphysiotomy also can be performed to allow disimpaction of the fetal shoulders. Both of these procedures can be very difficult, are associated with high maternal and fetal morbidity, and should be performed only when other conventional maneuvers have failed."
So Blueprints really missed this one
|
| young_doc
Forum Guru
Topics: 58
Posts: 737
|
That's what i figured...every OB resource that i also looked into made no mention of an Episotomy as an option in Shoulder Dystocia..
Thanks Vradojc1!
___________________
First Aid is my Bible...
|
|
| |
| | | |
Similar forum topics