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Shoulder Dystocia - NHS Forth Valley

Shoulder Dystocia - NHS Forth Valley

Consultation and Change

Consultation and Change Record – for ALL documents Contributing Authors: Consultation Process: Distribution: Debbie Forbes/Kirsty MacInnes Circulation to all Midwives, Obstetricians, Supervisors Of Midwives, Team Leaders, Clinical Shift Co-ordinators, Department Managers, Unit Service Manager and Head of Midwifery Midwives, Obstetricians, Supervisors Of Midwives, Team Leaders, Clinical Shift Co-ordinators, Department Managers, Unit Service Manager and Head of Midwifery Change Record Date Author Change Version 05/08/2014 KMacI Changes highlighted in blue 2.0 05/08/2014 KMacI Addition of flowchart for management of shoulder dystocia 2.0 05/08/2014 KMacI Addition of flowchart for Symphysiotomy 2.0 Version 2.0 5 th August. 2014 Page 2 of 8 UNCONTROLLED WHEN PRINTED

NHS Forth Valley Women & Children’s Unit SHOULDER DYSTOCIA H. E.L.P.E.R.R. 1 When diagnosis of shoulder dystocia is made further traction on neck must not be made until McRoberts Position is adopted (Grady et al 2007) HELP Call for Help 2222 - Experienced Midwife, Middle Grade Doctor, SHO, and Paediatric Middle Grade Doctor (Obstetric Anaesthetist, ODP and Consultant Obstetrician may also need to be called) Call for help Midwife Obstetrician Paediatrician Anaesthetist Note the time of delivery of the head, lay bed flat and arrange so that woman’s buttocks overhang the edge of the bed EVALUATE The Need for Episiotomy – Consider the need for episiotomy. If indicated the assistant should hold up the baby’s head to allow the person performing the delivery to check for nuchal cord & put fingers in to protect the neck while the episiotomy is being performed. An episiotomy creates space for internal rotational manoeuvres LEGS Mcrobert’s Manoeuvre – Bed is flattened. The woman’s thighs are sharply flexed, abducted and rotated outwards. Attempt delivery PRESSURE External Pressure – Suprapubic pressure is applied. A “cardiac massage” grip is used, with pressure to the posterior aspect of the shoulder with the heel of the hand. It is important to know where the fetal back is so pressure can be applied in the right direction • First constant “pressure” for up to 30 seconds - the operator applies traction on the fetal head - avoid excessive lateral flexion. If this is unsuccessful • “Rocking” movement for up to 30 seconds Evaluate For episiotomy Legs McRoberts Manoeuvre Pressure suprapubic Constant then rocking 30-60 sec Version 2.0 5th August 2014 Page 3 of 8 UNCONTROLLED WHEN PRINTED

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