COMPLICATION DURING AND AFTER R- Rotation of posterior shoulder

M-

DYSTOCIA- Wood’s corkscrew

 180
Manual Delivery of Post arm- insert hand into the vagina
DYS- difficult, painful, disordered and flex the posterior arm of the fetus, bringing it across the
chest. The posterior arm is the delivered over the perineum
Types of Dystocia
which allows the provider to rotate the fetus to allow delivery
1. Uterine Dystocia (abnormalities of power)
of the anterior
Gaskin or All four maneuver- increases the flexibility of
Hypotonic Uterine Dysfunction
sacroiliac joint and gravity push the posterior shoulder
 Weak and infrequent contractions
anteriorly.
 Usually occurs during active phase
 Not painful
 Management:
Management:
If ALARMER maneuver are unsuccessful, the last resort
 Reevaluation pelvic size, R/O cephalopelvic
maneuvers that can be employed includes the ff:
disproportion
 Deliberate Clavicle Fracture
 Vaginal Delivery: Amniotomy, Augmentation of labor
 Zavanelli Maneuver (tinutulak si head pabalik)
 Cesarian Section if contracted pelvis is present
 General Anesthesia
 Provide supportive care.(we are giving comfort the
 Abdominal Surgery with Hysterectomy
patient and health teaching)
 Symphysiotomy (not practiced right now)
Hypertonic Uterine Dysfunction
What’s the reason why tinatanggal si uterus kapag C-section?
 Usually encountered in the latent phase
Bat nagkakaroon ng Abdominal Hysterectomy? So
 Contractions are too frequent but uncoordinated
nagkakaroon ng trauma, magiging dysfunctional na sya at
 Uterus does not relax completely in between contractions
magkakaroon na ng hemorrhage that lead the patient to
 Painful
death.
Complications:
 Fetal Distress and Death
Cephalopelvic Disproportion (CPD)
 Maternal Exhaustion
- occurs when a baby’s head or body
 Uterine rupture
 Macrosomia due to:
Hypertonic Uterine Dysfunction
 Hereditary factors
Management:
 Diabetes
 Reevaluation pelvic size, if pelvis is adequate, Vaginal
 Post Maturity (still pregnant after the due date has passed
Delivery will be attempted
) - 42 weeks in above
 Maintenance of fluid & electrolyte balance by IV
 Multiparity
infusion.
 Abnormal fetal positions
 Therapeutic Rest: given analgesics and sedatives to
 Small pelvis
promote rest.
 Abnormally shaped pelvis
 Keep bladder empty
 Watch for danger signs: Fetal Distress, passing of
 Management:
MSAF.
 Perform Ceasarian Section
 Continue Trial of Labor
Fetal Dystocia (abnormalities of the passenger)
 Confirmation of the baby’s position with a vaginal exam
 Shoulder Dystocia
 Other test such as X-ray (Pelvimetry) or MRI to
visualize the baby’s head and our pelvis
 Close monitoring of contractions, dilation and baby’s
progression down the birth canal.
 WARNING SIGNS of Shoulder Dystocia
 Close monitoring of the baby’s movement and heart
 Prolonged second stage of labor (matagal)
rate .
 Head bobbing, retraction of head back into the pelvis
 Changes of positions are also advised.
(bumabalik ung ulo sa loob dahil nawawala ang
 If labor progress Forceps or Vacuum may be needed to
contraction)
help deliver the baby.
 TURTLE SIGN at delivery, ie the delivered head gets
pulled back towards perineum (naipit tas namamaga)

 AVOID applying pressure to the fetal head and neck

 AVOID applying fundal pressure.
Why di inaallow ang fundal push? Malaking problem, that
leads to hemorrhage.

 Management:
A- Ask for help
L- Lift leg/ hyper flex leg (Mc Robert’s Maneuver)
A- Anterior shoulder disimpaction