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Shoulder Dystocia - NHS Forth Valley

Shoulder Dystocia - NHS Forth Valley


NHS Forth Valley Women & Children’s Unit Shoulder Dystocia H. E.L.P.E.R.R. 4 Flowchart for Symphysiotomy Version 2.0 5 th August 2014 Page 6 of 8 UNCONTROLLED WHEN PRINTED

Place woman in lithotomy with legs supported by 2 assistants Angle between legs never more than 60-80° to avoid strain on sacroiliac joint Inject local anaesthetic into skin and symphysis pubis This identifies joint space and needle can be left in situ as guide if joint has been difficult to locate Insert urinary catheter Index finger pushes catheter and urethra to the side and middle finger remains on posterior aspect of pubic joint to guide scalpel Incise symphysis pubis in the midline at junction of upper and middle thirds Use the upper third of uncut symphysis as a support to lever the scalpel for incision of lower two-thirds of symphysis Remove scalpel and rotate through 180° and remaining upper third of symphysis is cut The symphysis cuts very easily, beware of injury to bladder or vagina Use large episiotomy to relieve tension on anterior vaginal wall Following delivery of baby and placenta compress symphysis between thumb and index fingers to promote haemostasis Leave urinary catheter in place for 5 days. Nurse woman on her side with knees strapped loosely together for 3 days, then begin mobilisation Adapted from Managing Obstetric Emergencies and Trauma 2003 Edited by Richard Johnson et al Version 2.0 5 th August 2014 Page 7 of 8 UNCONTROLLED WHEN PRINTED

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