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SHOULDER DYSTOCIA

THERESIA WITAYOSI

FAA 111 0030

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Incidens

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Definition

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Risk Factors

Term infants with shoulders wider than thesize of the head

Presence the DOPE (diabetes, obesity,prolonged pregnancy, excessive fetal size or

maternal weight gain) Long rst stage

Prolonged labor

Long II stage

Toxin stimulation

Vaginal delier! with action

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DiagnosisThe bab!"s head is born # but the shoulder restrained and can not be bThe bab!"s head is born # but $ee% %ressing the ula tight%ulledTraction on the head is not successfull!

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Prevention

&hen the high ris$ cesarean delier! with 'unusuall! large of fetus ( ) $g*# er! large of fetus

( +#) $g* with maternal diabetes# large of fetus( + $g* with a histor! of %reious distocia# with IIlengthwise with a large fetus,

Identif! and treat diabetes in mothers

-lwa!s be %re%ared when the time occurs

.ecognize the existence of d!stocia as earl! as

%ossible (attem%t to %ush# %ress the fundus andsu%ra%ubic and traction*

/ote the time and immediatel! as$ for hel% sod!stocia un$nown,

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Complication

0one fracture (claicula and humerus* 0rachial %lexus in1ur!

2!%oxia %ermanent brain damage

0leeding birth canal laceration# e%isiotom!#

atonic uterus,

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Management

-oid + P '3, Panic4, Pulling5, Pusshing

+, Pioting

-L-.6 '- ' as$ for hel%L ' Lift the legs 7 buttoc$s

- ' anterior shoulderdisim%action. ' rotation of %osterior

shoulder6 ' manual remoal %osteriorarm

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A : Ask For Help

8all a hel%er to hel%

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L : lift the legs & buttocks( McRoberts Maneuver )

6others in the su%ine %osition 9lex the thighs so the $nee becomes as close

as %ossible to the chest

.otate the legs towards the outside

Do e%isiotom! with wide enough

E%isiotom! : 6c.obert;s 6aneuer to

facilitate the %osterior shoulder %ast the%romontor! and into the %elis

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A : Anterior Shoulder Disimpaction(Rubin manuver)

The bab!"s shoulders that wedged is %ushedawa! from the midline of mother# %ressed onto% of the s!m%h!sis mother , The su%ra%ubic%ressure is to encourage the %osterior

shoulder of bab! to be remoed from the birthcanal and used the car%us

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R: Rotation Of Posterior Shoulder( Woods Screw Maneuver)

degrees so thatthe %osterior shoulder become the anteriorshoulder and the %osterior shoulder into

%osition under the %ubic arch # while theanterior shoulder into the %elic and turnedinto a %osterior# so that the anterior shoulderso eas! to be born

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R: Rotation Of Posterior Shoulder( Woods Screw Maneuver)

degrees so thatthe %osterior shoulder become the anteriorshoulder and the %osterior shoulder into

%osition under the %ubic arch # while theanterior shoulder into the %elic and turnedinto a %osterior# so that the anterior shoulderso eas! to be born

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M: manual removal posterior arm(Shwartz)

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After the management

-lert the bleeding after childbirth

Ins%ection the %resence of maternallacerations and trauma

chec$ the bab! Informed consent

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...Thank you...