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CASE SECNARIO IN OBSTETRIC EMERGANCIES

Prepared by Dr MANAL BEHERY ASSISTANT PROFESSOR Zagazig University. CASE SECNARIO IN OBSTETRIC EMERGANCIES. Definition of Obstetrical Emergencies. Life -or -death situation Infrequent, unanticipated, unpredictable nightmare. Case 1 Shoulder dystocia.

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CASE SECNARIO IN OBSTETRIC EMERGANCIES

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  1. Prepared by Dr MANAL BEHERY ASSISTANT PROFESSOR Zagazig University CASE SECNARIO IN OBSTETRIC EMERGANCIES

  2. Definition of Obstetrical Emergencies • Life -or -death situation • Infrequent, unanticipated,unpredictable nightmare

  3. Case 1Shoulder dystocia

  4. 20 years G2P1, with diabetes, 42 wks pregnant, and her first baby was 9 lbs. Now fully dilated and pushing… • Head delivers, then retracts tightly against the perineum • “turtle sign”

  5. NOW WHAT? A. Panic B. Hide C. Drop out & apply for dermatology D. Be a Hero

  6. Be a Hero • CALL FOR HELP! • Stop Pushing! • McRoberts • Suprapubic CPR • Episiotomy? • Maneuvers • Roll patient • Clavicle Fracture • Symphysiotomy

  7. McRoberts&Suprapubic CPR McRoberts& Suprapubic CPR

  8. How McRoberts work? • hyperflexion of maternal hips Increases intrauterine pressure (1,653mmHg - 3,262 mmHg) • Increases amplitude of contractions (103mm Hg to 129mm Hg)

  9. Episiotomy? • Provides extra hand room for maneuvering. • Does not help with the body impaction.

  10. Maneuvers 1. Rubin II 2. Ruben II + Woods Corkscrew 3. Reverse Woods Corkscrew

  11. Rubin’s Maneuver • Adduction of the most accessible shoulder • Moves the fetus into an oblique position and decreases the biacromial diameter

  12. Woods’ Cork Screw Maneuver Abduct posterior shoulder exerting pressure on anterior surface of posterior shoulder

  13. Deliver posterior arm(Barnum Maneuver) grasp the posterior arm and sweep it across the anterior chest to deliver

  14. All-Fours Maneuver(Gaskin Maneuver • Roll Patient • Can increase outlet by 20 mm. • Apply downward traction to disimpact post shoulder

  15. Suprapubic Pressure direct posterior or oblique suprapubic pressure

  16. Zavanelli Maneuver cephalic replacement via reversal of the cardinal movements of labor

  17. Clavicular Fracture Fracture the anterior clavicle by pushing it against the pubic ramus or using a closed pair of scissors

  18. Symphysiotomy() • Foley • Betadine • 20 or 21 blade, cut till it opens

  19. To easy remember • Help – obstetrician, pediatrician • Episiotomy • Legs – elevate (McRoberts) • Pressure - suprapubic • Enter vagina – Rubin’s and Woods’ screw • Roll or Remove posterior arm • Zavanelli, Clavicular# , Symphysiotomy

  20. Case Two – Cord Prolapse

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