This phenomenon is where the fetal head enters and retracts from the vaginal canal, like a turtle sticking its head out of its shell. The presence of a "turtle sign" can identify shoulder dystocia. It is important to quickly recognize and treat this complication because prolonged dystocia can result in fetal asphyxiation, clavicle fracture, and brachial plexus injury. This complication is difficult to anticipate, but risk factors include macrosomia, maternal diabetes, maternal obesity, and fetal postdates. It occurs when the width of the fetus's shoulders is too broad to fit through the mother's pelvic outlet, resulting in the fetus becoming lodged in the birth canal. Shoulder dystocia is one of the most common intrapartum pregnancy complications. If the placenta is not intact, the retained products will need to be retrieved to prevent bleeding or later infection. Once the placenta has been delivered, it needs to be inspected for any missings pieces. This will cause the stringy delicate membranous tail of the placenta to wrap around itself, providing greater structural integrity, preventing retained products of conception. Once the placenta is approximately halfway out of the vaginal os, begin to twist the placenta as traction is maintained. Once the placenta is visible, grab it, continuing to pull downward. Slowly increase the amount of traction on the cord until the placenta begins to descend. These are a consequence of the placenta separating from the uterine wall and beginning its descent. The placenta is ready to deliver when the uterus becomes more firm, there is a gush of blood from the vagina, and there is a lengthening of the umbilical cord. The cord can be quite slippery, so it is best to hold onto the cord with either a needle driver, Kelly forceps, or a hemostat. Applying fundal pressure/uterine massage will stimulate uterine contraction, promoting the placental release and preventing post-partum hemorrhage. While waiting for the placenta to deliver, apply gentle traction on the cord. This should occur between 5 and 30 minutes after delivery. This promotes bonding and helps keep the child warm.Īfter the neonate has been successfully delivered, the placenta must be delivered. As it is unlikely that an ambient warmer will be available in the prehospital setting, skin-to-skin contact between child and mother is strongly encouraged. If available, use a clean towel to dry and stimulate the infant. The second clamp should be placed approximately 5 cm apart from the first, this will allow adequate space to safely cut the umbilical cord with a sharp pair of scissors. This provides adequate spare cord to place an umbilical catheter if necessary once the neonate reaches the hospital if they require neonatal resuscitation. Generally, it is advised that the proximal umbilical clamp is placed approximately 10 centimeters from the umbilicus. It is advised to wait at least 30 seconds before clamping the cord this allows for autotransfusion of some of the placental blood into the neonate. There is no rush for the prehospital provider to clamp or deliver the placenta. From here, the passage of the rest of the body should happen quickly and spontaneously, with little effort on the provider's part. Then gently pull upward releasing the posterior shoulder. This will help release the anterior shoulder from catching on the mother's boney pelvic rim. At this point, the shoulders will be delivered, with the head facing the mother's inner thigh, grasp the head and pull downward with gentle traction. If the umbilical cord is felt wrapped around the neck, the cord will need to be reduced. Once the head is delivered, sweep fingers around the fetal neck feeling for a nuchal cord. The other hand can be used to place pressure on the perineum, providing this area with support as this is the most common area for a laceration. To prevent lacerations, as the mother is pushing, place one hand on the fetal scalp, applying pressure and allowing for a slower and more controlled expulsion of the fetal head from the vagina. These occur when the fetal head is forcefully and quickly expelled from the vagina. Peri-vaginal tears are a common complication of delivery. This process can be quite exhausting for the mother, so generally, the mother is encouraged to push for 3 sets of 10 seconds during a contraction then take a break. When the mother is experiencing a contraction, be sure to coach the mother by encouraging her to push for a full 10 seconds, if possible. Around the time of delivery, the patient will begin experiencing strong contractions around 2 to 4 minutes apart.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |