TEALE FENNING

bronwyn · Posted: Mon Jul 24, 2006 5:20 pm Post subject: Shoulder dystocia

You are called into a delivery room by a senior midwife having difficulty delivery fetal shoulders. On arrival the woman is in lithotomy position, the head delivered 2 minutes earlier but moderate traction thus far has failed to deliver the shoulders
A) No additional intervantion at this stage
B)LSCS
C)increase dose oxytocin
D) Lovesets
E)reduce dose oxytocin
F)FBS
G)Forceps
H)deliver posterior arm
I) episiotomy
J) inhaled salbutamol
K)Mac Roberts
L)administer maternal facial oxygen

I answered I, correct answer K.
The only reason I answered I was that it comes first in HELPER! Evaluate for episiotomy before starting all manouvres, no?
Logically though, when I do fly into the room in such dire circumstances, I would ask for Mac Roberts first!
Not sure then
HELP Rolling Eyes

_________________
Bronwyn Bell
SpR
Portsmouth

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

hi bron,

mac roberts first. MOET manual suggests that episiotomy is not a compulsary step in the management -- RCOG guideline , as the mac roberts may resolve a majority of the cases and is safe -- SaFE study. i was told the exact same thing at the MOET course too.

also with the woman in exaggerated lithotomy, i think the episiotomy will be easier to perform with regards visualisation as the pelvis and the perineum are tilted more towards us.

raj

Nick Raine-Fenning · Posted: Mon Jul 24, 2006 10:52 pm Post subject:

McRoberts' is correct - no argument

HELPER is there to help people remember the order and things to do. Don't get me started on this as Shoulder Dystocia is one of those questions I would set as an absolute pass / fail question.

This is a very important area. I feel is unacceptable to present yourself for Membership if you cannot handle a shoulder dystocia or a maternal collapse, PPH etc.

What worries me more is that this mnemonic has actually put Bronwyn off doing what she instinctively knew was correct.

The role of episiotomy is patient / case specific and it is only needed to allow access for delivery of the posterior shoulder etc.

Think about the mechanics of this - the shoulder in most cases (but not all as we learned on the O&G in 48 hrs course) is wedged behind and symphysis pubis. Episiotomy is not going to help.
_________________
"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997

Nick Raine-Fenning · Posted: Tue Jul 25, 2006 8:04 am Post subject:

I'm only angry about this as it reminds me of the good old days when I did obstetrics and the discussions one has with midwives!!
_________________
"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997

bronwyn · Posted: Tue Jul 25, 2006 10:48 am Post subject:

Will try not to anger you again Twisted Evil

Apologies
PS: don't knock the madwives....they do a good job down here in Poole Wink

_________________
Bronwyn Bell
SpR
Portsmouth