tailieunhanh - obstetrics_part7

vai dystocia 6. Malpresentations và lao động dystocia Giao hàng tận nơi không có thể tiến triển sau khi đầu ra, bởi vì vai bị ảnh hưởng trong xương chậu. Vai dystocia là đặc biệt phổ biến khi thai nhi quá lớn. | 6. Malpresentations and labour dystocia Shoulder dystocia Delivery cannot progress after the head is out because the shoulders are impacted in the pelvis. Shoulder dystocia is especially common when the foetus is large. This is a life-threatening emergency for the foetus foetal distress then rapid death by asphyxiation . Management - Hyperflexion of the mother s thighs. - Suprapubic pressure have an assistant press firmly just above the symphysis pubis to try to reduce the diameter of the shoulders and help them engage. - If this fails bring down one foetal arm to reduce the diameter of the shoulders and allow delivery Kneel to get the proper axis of traction. Reach in to find the posterior arm and bring it to the vaginal opening slide a hand behind the foetus head and move it along his arm trying to get hold of his hand. Grasp it and draw it down along his abdomen to the vaginal opening. The delivery can then continue. If it is impossible to get hold of the hand place two fingers along the humerus like a splint. Bend the elbow and sweep the humerus across the chest to bring down the arm. - If this fails and the infant is alive consider symphysiotomy. - After these manoeuvres carefully examine the vagina since lacerations are common. 6 Above all do not - Apply excessive traction to the foetal head as this can rupture the brachial plexus on the side of the anterior shoulder. - Pivot the head by twisting the neck as this can also cause neurological injury. This is trial version Transverse lie and shoulder presentation Transverse lie and shoulder presentation A transverse lie constitutes an absolute foetopelvic disproportion and delivery by natural means is impossible. This is an obstetric emergency because labour is obstructed and there is a risk of uterine rupture and foetal distress. Diagnosis - The uterus is very wide the transverse axis is virtually equivalent to the longitudinal axis fundal height is less than 30 cm near term. - On examination .