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Malposition - Coggle Diagram

- - - - good uterine contractions
      - flexion
      - decent
    - - persistent occipitoposterior position (face to pubes)
      - head fails to flex and the siniciput becomes the leading part
      - deep transverse arrest
- - - - 3rd / 4th degree tear
      - PPH
      - Uterine Rupture
      - future obstetric issues
      - psychological effects of a birth trauma
    - - brachial plexus injury
      - risk of hypovolaemia
      - hypoxia
      - death
      - fractured clavicle / humourus
  - - - 1.Call code / Emergency / Shoulder Dystocia
      - 2.McRoberts Maneuvere
        
        Woman in recumbent position - flat no pillows
        
        Both thighs are abducted and hyperflexed to the abdomin
        
        Works in 40-90% of cases
      - Rubin 1 / Suprapubic Pressure
        
        Gentle downwards traction on baby's head
        
        CPR hand position over fetal anterior shoulder. Applying continuous pressure
        
        if internal rotations may be required now is the time to cut episiotomy
      - Internal manoeuvres / Rubin's 2
        
        only if 2 & 3 have been unsuccessful
        
        manoeuvres are to internally rotate the shoulders or deliver the posterior arm to reduce the bisacromial diameter
        
        hand is held in putting on tight bracelet postion
        
        Rubins 2 - digital pressure is applied to the posterior aspect of the anterior shoulder pushing it towards the fetal chest
        
        Wood's screw manoeuvere - accoucheur introduces the second hand and locates the anterior aspect of the posterior shoulder. pressure is applied to rotate the posterior shoulder
        
        Reverse Wood's screw manoeuvere
        
        Delivery of the posterior Arm - accoucheur identifies the posterior arm and elbow. Applying pressure to the antecubital fossa to flex the elbow in front of the body or grasp the posterior hand to sweep the arm across the chest to deliver the arm
        
        Movement of the woman onto all 4's
    - - time of birth of head
      - maneuveres performed (timing and sequence)
      - the direction baby is facing and which shoulder is impacted
      - time of delivery of the body
      - staff in attendence
      - the condition of the baby at birth
      - describe by degree of difficulty effecting birth
        
        Mild - McRoberts / Suprapubic pressure
        
        Moderate - Rubin 2 / Woods or reverse woods/ posterior shoulder delivery
        
        Severe - Fractured clavicle or humerous
        
        Undeliverable - Cephalic replacement and abdominal rescue
- - - - with good uterine contractions, decent and rotation labour can progress to normal birth
    - - unless this rotates to a mento-anterior position this be not birth vaginally - obstructed labour
- - - - excessive space
        
        impaired fetal growth
        
        grand multi
        
        polyhydramnios
    - - multiple pregnancy
      - placenta preavia
      - oligiohydramnios
      - uterine malformations eg bicornate uterus or fibroids
    - - congenital malformations/abnomaly
      - SGA
      - female fetal sex
    - - anti-convulsant drugs
      - history of breech presentation
      - gestational diabetes
      - advanced maternal age
  - - - cord prolapse
      - head stuck
        
        Mauriceau Smellie Veit manoeuvre
        
        Dührssen incision
    - - perineal damage
        
        upright birth
        
        hand off approach
      - c-section