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Shoulder dystocia charting

Ob/Gyn   (7,934 Views | 10 Replies)

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Does anyone have guidelines on what to chart when a shoulder dystocia occurs? Even if you don't have formal guidelines what are some of the thing you always chart? We were discussing this at work and at my hospital we don't consistently chart on it.

Thanks for any information.

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at your cervix has 10 years experience and specializes in OB, Post Partum, Home Health.

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The main things to chart are the length of the dystocia (time between delivery of head and delivery of the body) and maneuvers utilized to relieve the dystocia (such as McRoberts, Woods-Corkscrew, suprapubic pressure, hands-knees position, zaphanelli, etc.), length of time each maneuver applied, effectivness, and of course the condition of the infant after delivery. You would want to be sure to notify the pediatrician, and watch for any signs of fx clavicle or brachial plexis injury.

Hope this helps a little.

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93 Posts; 1,817 Profile Views

The main things to chart are the length of the dystocia (time between delivery of head and delivery of the body) and maneuvers utilized to relieve the dystocia (such as McRoberts, Woods-Corkscrew, suprapubic pressure, hands-knees position, zaphanelli, etc.), length of time each maneuver applied, effectivness, and of course the condition of the infant after delivery. You would want to be sure to notify the pediatrician, and watch for any signs of fx clavicle or brachial plexis injury.

Hope this helps a little.

What is zaphanelli? I've been doing L&D for over 8 years and haven't heard of this?:confused: Thanks

Beth

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at your cervix has 10 years experience and specializes in OB, Post Partum, Home Health.

203 Posts; 3,933 Profile Views

Zaphanelli (or Xaphinelli or something like that) is a rarely used maneuver in which the shoulder dystocia is so severe that no other maneuvers work, you push the head back in and do a c-section. I have seen it done 3 times in my 8 years, once the baby was breech and we had head entrapment and pushed the body back in. Not pleasant!!!!!!!

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86 Posts; 2,535 Profile Views

Thanks for the information. Thats pretty much what I found. Zavanelli maneuver is a manuever of last resort. It's pushing the head back in by reversing the mechanism of delivery. Tocolysis would be given and a c-section performed. High morbidity with this procedure.

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23 Posts; 866 Profile Views

As a nurse, I chart exactly what I did (lowered head of bed, applied suprapubic pressure, etc.) I also chart time of code light pulled, who responded, who did what and of course length of time of dystocia. I also chart to "see provider note". The provider needs to chart what manuevers they did. Also, read the provider note because you might be really surprised how some providers try to set the nurse up in their charting (this applies to all emergencies or less than optimal outcomes).

As someone who is frequently on our unit's emergency team, I am amazed at how many rooms I go into that are doing McRobert's with the head of the bed still up. I even saw this on a "maternity ward" episode. I was screaming at the tv "put the head of the bed down, put the head of the bed down!" I also am surprised at the seeming reluctance of many providers at my facility to cut an episiotomy during a dystocia. Anyone else seen this at your facility?

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93 Posts; 1,817 Profile Views

Thanks for the info. I've heard of it but didn't know it's name. Thankfully, I've never had to be present for that! My worst shoulder was resoved with woodscrew.

Beth

Zaphanelli (or Xaphinelli or something like that) is a rarely used maneuver in which the shoulder dystocia is so severe that no other maneuvers work, you push the head back in and do a c-section. I have seen it done 3 times in my 8 years, once the baby was breech and we had head entrapment and pushed the body back in. Not pleasant!!!!!!!

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SmilingBluEyes has 20 years experience.

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smart group here. KNOCK ON WOOD, only one case of true dystocia that required my intervention.....suprapubic pressure and the dr doing her thing. It was enough for me....I have been lucky thus far. On that vein, anyone here work at a place that does "dystocia drills"??? (kinda like mock code). Probably would not hurt for us less-experienced folks!

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mitchsmom specializes in OB, lactation.

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I also am surprised at the seeming reluctance of many providers at my facility to cut an episiotomy during a dystocia.

Do you mean for after McRoberts & suprapubic pressure - like for corkscrew & the other more invasive manuevers? Doesn't seem like it would help during the McRoberts/suprapubic steps. Or am I wrong?

My last was a shoulder dystocia baby and they did McRoberts & suprapubic, no episiotomy needed (room for the baby wasn't the problem- it was only that his shoulder was stuck of course & he came right out fine with suprapubic pressure, and the doc didn't need extra room for the early maneuvers).

So I was just curious about more details on how or if episiotomy relates to the McRoberts/suprapubic/non invasive measures. And I wonder why they would be reluctant? Dystocia always sounds like such a grave situation that I'd think they'd immedidately do anything that would help???

About what % of the time do you all think your dystocias necessitate maneuvers beyond McRoberts/suprapubic pressure?

Just trying to learn, please ignore if I'm being pesty :D

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68 Posts; 2,274 Profile Views

Does any one use the Gaskin Maneuver developed by midwife Ina May Gaskin?

Do you mean for after McRoberts & suprapubic pressure - like for corkscrew & the other more invasive manuevers? Doesn't seem like it would help during the McRoberts/suprapubic steps. Or am I wrong?

My last was a shoulder dystocia baby and they did McRoberts & suprapubic, no episiotomy needed (room for the baby wasn't the problem- it was only that his shoulder was stuck of course & he came right out fine with suprapubic pressure, and the doc didn't need extra room for the early maneuvers).

So I was just curious about more details on how or if episiotomy relates to the McRoberts/suprapubic/non invasive measures. And I wonder why they would be reluctant? Dystocia always sounds like such a grave situation that I'd think they'd immedidately do anything that would help???

About what % of the time do you all think your dystocias necessitate maneuvers beyond McRoberts/suprapubic pressure?

Just trying to learn, please ignore if I'm being pesty :D

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SmilingBluEyes has 20 years experience.

2 Followers; 19,599 Posts; 66,328 Profile Views

And, yes, we have used Gaskin's maneuver, (and it does work!)--- but it is only useful if a person has NO epidural anesthesia. Obviously in the presence of an epidural, movement that allows us to try Gaskin's maneuver is a real problem. We have a high epidural rate, so Mc Robert's manuever is the first thing we try, then suprapubic pressure, and episiotomy.

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