Tuesday, November 26, 2013

Shoulder Dystocia,When you wish those 7 minutes never end

Normal Delivery is good.It is simple and it is easy.You just have to hold the baby who anyways the mother is pushing out.True most of the times,Normal deliveries can be quite scary at times.Thus a doctor who isn't well versed in managing acute Obstetric emergency shouldn't try a vaginal delivery without adequate back up.
In Uk and other countries which have structured protocol based training Shoulder Dystocia drill happens quite frequently.In India in the absence of such drills it can be a nightmare if encountered in one of the deliveries.
Recently One of my patient had shoulder Dystocia and quite bad at that.Shoulder dystocia is a condition when the shoulder of the baby can't come out vaginally after the baby's head has been delivered.It can happen at any weight of the baby.So the lady was in labour for more than 15 hours or so and then she got exhausted.Asked for help in the form of assisted delivery.I successfully pulled the baby out who was in occipito posterior position ( Baby's back was towards mother back).And then started the struggle.The shoulder receded back.And an attempt by Dr Deepa to pull the baby out failed.And flexing the thigh and macroberts maneuver and all failed.
Now in this situation 'seven minutes' is all what you have got to deliver the baby or otherwise the baby is brain dead.So injury to mother,fracture of baby's hand bones( humerus) and clavicle is the last concern.You just want the baby out.
Having attended many drill in Uk,I managed to keep myself calm.Did a wood screw maneuver.and baby delivered with some difficulty.In bargain he got a crack in the clavicle.
Why did I write this post
a) I am proud of myself :-) that I could keep my calm.
b) To make would be parents aware that shoulder dystocia is a reality and expect the possibility during any delivery.My patients were very understanding and they had all the good words to say for the good work done.
C) Last but not the least .......all junior Gynaecologists please go through the shoulder dystocia management guidelines and please review thw maneuvers and it's techniques.

1 comment:

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