Assignment

Shoulder dystocia

Cord prolapse
 SHOULDER DYSTOCIA
Incidence.0.15-1.7% of vaginal
delivery.
Risk factors
Fetal macrosomia
Gestational DM
HX shoulder dystocia
Post term pregnancy
Maternal obesity
Hx macrosomia
 MX.
Mc Robert’ s maneuver(success rate 42%)
Rubin “

Wood’s “

Deliberate fracture of clavicle

 Complications

Fracture humerus, clavicale(injurey to

brachial plexus 10-15%do not resolve)
PPH
Laceration(cervix…)
Umbilical cord prolapse
INTRODUCTION

 It is an obstetrical emergency because the prolapsed

cord is vulnerable to compression, umbilical vein
occlusion, and umbilical artery vasospasm, which can
compromise fetal oxygenation.
Overt vs occult
RISK FACTORS 
 Malpresentation (breech, transverse, oblique, or unstable lie)
 Prematurity
 Low birth weight
 Second twin
 Low lying placentation
 Uterine malformations/tumors
 Multiparity
 Polyhydramnios
 Long umbilical cord
 Unengaged presenting part
CLINICAL FINDINGS 
 Cord prolapse usually presents with the abrupt onset of severe,
prolonged fetal bradycardia or moderate to severe variable
decelerations in a patient with a previously normal tracing .
 The fetal heart rate changes typically occur soon after membrane
rupture or an obstetric intervention that dislodges the presenting
part.
 Less commonly, the care provider may palpate a pulsating cord
incidentally on a vaginal examination performed to assess labor
progress or a patient with ruptured membranes may report seeing or
feeling an overt cord prolapse.
MANAGEMENT OF INTRAPARTUM CORD PROLAPSE
Call for assistance and prepare for emergency delivery
Initiate maneuvers for intrauterine resuscitation
Monitor the fetal heart rate
If the prolapse is overt:Minimize manipulating an
overtly prolapsed cord and avoid exposing it to the
cold environment,
Perform emergency delivery by the most rapid and
safe route, which is typically cesarean
If the prolapse is occult:
Manually elevate the presenting part 
Place patient in Trendelenburg or knee chest position
Retrofill the bladder 
Administer a tocolytic