Malpresentations and Positions & Operative Obstetrics
You are delivering a 26- year old G3P2 at 40 weeks. She has a history of two previous uncomplicated vaginal deliveries and has no complications this pregnancy. After 15 minutes of pushing, the baby’s head delivers spontaneously, but then retracts back against the perineum. As you apply gently downward traction to the head, the baby’s anterior shoulder fails to deliver. All of the following are appropriate next steps in the management of this patient except
|A||Instruct the nurse to apply fundal pressure|
|B||Cut a generous episiotomy|
|C||Instruct the nurse to apply suprapubic pressure|
|D||Instruct the nurse to flex this patient’s leg back to her head|
Instruct the nurse to apply fundal pressure
a. In this clinical scenario, a shoulder dystocia is encountered.
b. A shoulder dystocia occurs when the fetal shoulders fail to spontaneously deliver secondary to impaction of the anterior shoulder against the pubic bone after delivery of the head has occurred. Shoulder dystocia is an obstetric emergency and one should always call for help when such a situation is encountered. A generous episiotomy should always be made to allow the obstetrician to have adequate room to perform a number of manipulations to try to relieve the dystocia.
c. Such maneuvers include the following: suprapubic pressure, Mc Robert’s maneuver (flexing maternal legs upon the abdomen), Wood’s corkscrew maneuver (rotating the posterior shoulder) and delivery of the posterior shoulder.
d. There is no role for fundal pressure because this action further impacts the shoulder against the pubic bone and makes the situation worse.