tailieunhanh - Phương pháp điều trị sản khoa - Tình huống số 2

Tham khảo tài liệu 'phương pháp điều trị sản khoa - tình huống số 2', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 11 A 25-ycar-old Ì2 Pl woman is delivering at 42 weeks gestation. She is moderately obese but the fetus appears clinically to be of about 3700 g weight. After a 4-hr first stage of labor and a 2-hr second stage of labor the fetal head delivers but is noted to be retracted back toward the patient s introitus. The fetal shoulders do not deliver even with maternal pushing. What is your next step in management What is a likely complication that can occur because of this situation ì 04 CASE FILES OBSTETRICS AND GYNECOLOGY ANSWERS TO CASE 11 Shoulder Dystocia Siininiary A 25-year-old obese G2 Pl woman is delivering at 42 weeks gestation the fetus appears clinically to be 3700 g average weight . After a 4-hr first stage of labor and a 2-hr second stage of labor the head delivers but the shoulders do not easily deliver. Next step in management McRobert s maneuver hyperflexion of the maternal hips onto the maternal abdomen and or suprapubic pressure . Likely complication A likely maternal complication is postpartum hemorrhage a common neonatal complication is a brachial plexus injury such as an Erb s palsy. Analysis Objectives 1. Understand the risk factors for shoulder dystocia. 2. Understand that shoulder dystocia is an obstetric emergency and be familiar with the initial maneuvers used to manage this condition. 3. Know the neonatal complications that can occur with shoulder dystocia. Considerations The patient is multiparous and obese both of which are risk factors for shoulder dystocia. There is no indication of gestational diabetes which would also be a significant risk factor. The patient is post-term at 42 weeks which increases the likelihood of fetal macrosomia. The patient s prolonged second stage of labor upper limits for a multiparous patient is 1 hr without and 2 hr with epidural analgesia may be a nonspecific indicator of impending shoulder dystocia. Nevertheless the diagnosis is straightforward in that the fetal shoulders are described Al. CASHS I