Shoulder dystocia midwifery

Shoulder dystocia: After the fetal head is delivered, the front shoulder of the fetus is incarcerated above the pubic symphysis, and the fetal shoulders cannot be delivered by conventional midwifery. Its surgery is called shoulders dystocia (operationsforshoulderdystocia). Treating diseases: dystocia Indication Shoulder dystocia: After the fetal head is delivered, the front shoulder of the fetus is incarcerated above the pubic symphysis, and the fetal shoulders cannot be delivered by conventional midwifery. Contraindications There are serious obstacles to the coagulation mechanism. High blood pressure, diabetes, and some bleeding-prone diseases. Preoperative preparation At this time, the mother is very nervous, to appease the maternal mood and eliminate her nervousness; at the same time, we must constantly monitor the fetal heart. Surgical procedure 1. Flexor thighs midwifery method: Let the maternal hands hold the thighs or knees, try to flex the thighs, make the thighs close to the abdominal wall, reduce the curvature of the lumbosacral spine, reduce the pelvic tilt, increase the pubic symphysis to increase The exit plane helps the natural release of the front shoulder behind the pubic bone. This method is simple and effective, and can be delivered without the use of other special techniques. 2. Pressing the front shoulder method: When the above method is not effective, the assistant can pressurize the front shoulder of the fetus in the maternal pubic symphysis to reduce the circumference of the shoulder, and the receiver slowly pulls the fetal head downward and backward to make the incarceration The front shoulder is delivered, and this method often needs to be combined with other midwifery techniques. 3. Swivel method: the hand of the receiver reaches into the vagina, placed between the shoulder and the shoulder of the fetus, and the other hand puts the front shoulder of the fetus to rotate the shoulder to reach the pelvic slant path, so that the front shoulder is inserted into the basin, and the front shoulder is inserted into the basin. The front shoulder can be loosened and the back shoulder can be rotated 180°. When rotating the shoulder, be careful not to rotate the neck and the fetal head to avoid damage to the hip plexus. 4. First pull out the back shoulder to deliver the back shoulder method: first determine the fetal head orientation, if the fetus is on the right side with the right hand, on the left side with the left hand, the midwife hand squats into the vagina, put the index finger, middle finger tip After the fetal elbow fossa, then press the back elbow fossa to flex the fetus's elbow and forearm, then hold the baby's hand and pull the hand and forearm out of the vagina in the direction of the chest to deliver the back shoulder. 5. If the above method is ineffective, the fetal clavicle can be cut, and the soft tissue is sutured after delivery, and the lock can naturally heal. This method can give the fetus a chance. complication Hip plexus injury (1) gluteal plexus root laceration in the vertebral foramen: the upper limb sag, the hip and forearm are internal rotation deformity, it is difficult to repair, and more advocates the use of abduction stent to keep the nerve root relaxed, supplemented by acupuncture, physiotherapy and Neurotrophic and other drug treatments, but also pay attention to passive active limbs to prevent joint contracture. (2) nerve root laceration injury of the external foramen: due to the far distance from the spinal cord, the nerve elasticity is large, and if the damage is not serious, there is much hope for recovery. When surgical exploration is required, it is only suitable for nerve scar tissue lysis. (3) Brachial plexus injury for more than one year. If there is no significant improvement, it is often necessary to perform tendon transfer or arthrodesis to improve its function. 2. Clavicle fracture Due to the lack of self-reporting ability, the newborn is full of subcutaneous fat, the deformity is not obvious, and it is easy to be misdiagnosed. However, according to the medical history and careful examination, the head of the child is mostly deflected to the affected side, and the lower jaw is turned to the healthy side. When the upper limb or the hand is pressed against the clavicle, the child cries and touches the bone, and the x-ray film can confirm the diagnosis. Treatment only uses a triangle towel to suspend the affected limb for 1 to 2 weeks, and the displaced fracture is fixed with a "8" bandage for 1 to 2 weeks.

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