NURS 378 Clinical Case Study GRADING CRITERIA.

Shoulder dystocia is a serious situation that can take place during a vaginal delivery that needs urgent medical attention(Lopez, de Courtivron , and Saliba,2015). Newborn shoulder dystocia means where the baby’s head moves out of the birth canal and the fetal shoulder becomes trapped between the pelvic bones of the mother.NURS 378 Clinical Case Study GRADING CRITERIA.

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Unanticipated shoulder dystocia during vaginal birth can be a severe concern. The dystocia of the shoulder is characterized by the appearance of a “turtle sign” where the fetal head appears and retracts rapidly as the shoulder is wedged under the pelvic bones(Lopez, de Courtivron , and Saliba,2015). Therefore, a minute after the baby’s head is delivered, however, the neck does not emerge, shoulder dystocia is confirmed.NURS 378 Clinical Case Study GRADING CRITERIA.

Incidence of shoulder dystocia may be presumed when: infants weight is more than 4,500 grams; when prolonged conduction of anesthesia with diminished maternal bearing ability; when unstable labor occurs; and when more than 4,000 grams of active vaginal delivery occurs; and also when babies have diabetic mothers(Musa, 2015). The condition is difficult to anticipate and, in several cases, shoulder dystocia could occur spontaneously resulting in fetal and maternal complications.NURS 378 Clinical Case Study GRADING CRITERIA.

Maternal complications may include, uterine collapse, perineal lacerations as well as postpartum hemorrhage, whereas the effects for the infant could include broken clavicles, asphyxia, brachial palsy, phrenic nerve palsy facial paralysis, depressed skull fractures,  and intracranial hemorrhage caused by birth trauma.NURS 378 Clinical Case Study GRADING CRITERIA.

To minimize the incidence of shoulder dystocia fetal criteria, a detailed examination should be carried out using palpating and ultrasound of the abdomen of the mother, so that the weight and size of the infant can be measured(Huntley and  Smith, 2017). If it is estimated that the fetal weight is 4500 g or more, cesarean birth is generally advised. The preferred method of birth with an average fetal weight of about 4000 to 4500 g is questionable.NURS 378 Clinical Case Study GRADING CRITERIA.

When dystocia is presumed, the mother must be advised to push her legs wide apart. The nurse should clarify to the mother that the baby’s shoulders are complicated to get out, and also that she has to push hard to get out of the shoulders. Adjusting the position of the mother to her hands and knees may help deliver the infant. This being an emergency procedure, the individual may be aided into the McRoberts maneuver (Lok, Cheng, and  Leung, 2016).This is sharp flexion of the thigh towards the hips and abdomen, or the application a soft suprapubic pressure in an attempt to facilitate the birth of the fetal shoulders.NURS 378 Clinical Case Study GRADING CRITERIA.

Rubin II may be introduced, which involves placing the fingertips of one hand vaginally, behind the back of the anterior shoulder of the baby, and turning the shoulder towards the fetal chest. This movement is applied to the fetal shoulder girdle, which decreases its diameter. If the Rubin II technique is ineffective, the Woods corkscrew maneuver can be attempted(Huntley and  Smith, 2017). The surgeon puts two fingers specifically on the anterior aspect of the fetal posterior shoulder, applying delicate upward pressure along the diameter of the arc in the same orientation as Rubin II. This movement allows a more stable rotation.NURS 378 Clinical Case Study GRADING CRITERIA.

Conclusion

Careful monitoring of the infant should be carried out for the determination of any injuries and potential complications until the child is delivered. The infant should be carefully watched for signs of brain, neurological, and motor disorders. The mother should be assisted and presented with information on the issues involved with shoulder dystocia. It should be inspected for complications with the uterus, since it could be overstretched but might not contract well. If the fundus is unstable, so uterine atony is assumed and can be gently massaged to induce uterine contractions as well as avoid bleeding. Vital signs of the baby and the mother should be monitored closely for further assessment.NURS 378 Clinical Case Study GRADING CRITERIA.

Shoulder dystocia is a serious situation that can take place during a vaginal delivery that needs urgent medical attention(Lopez, de Courtivron , and Saliba,2015). Newborn shoulder dystocia means where the baby’s head moves out of the birth canal and the fetal shoulder becomes trapped between the pelvic bones of the mother.NURS 378 Clinical Case Study GRADING CRITERIA.

Unanticipated shoulder dystocia during vaginal birth can be a severe concern. The dystocia of the shoulder is characterized by the appearance of a “turtle sign” where the fetal head appears and retracts rapidly as the shoulder is wedged under the pelvic bones(Lopez, de Courtivron , and Saliba,2015). Therefore, a minute after the baby’s head is delivered, however, the neck does not emerge, shoulder dystocia is confirmed.NURS 378 Clinical Case Study GRADING CRITERIA.

Incidence of shoulder dystocia may be presumed when: infants weight is more than 4,500 grams; when prolonged conduction of anesthesia with diminished maternal bearing ability; when unstable labor occurs; and when more than 4,000 grams of active vaginal delivery occurs; and also when babies have diabetic mothers(Musa, 2015). The condition is difficult to anticipate and, in several cases, shoulder dystocia could occur spontaneously resulting in fetal and maternal complications.

Maternal complications may include, uterine collapse, perineal lacerations as well as postpartum hemorrhage, whereas the effects for the infant could include broken clavicles, asphyxia, brachial palsy, phrenic nerve palsy facial paralysis, depressed skull fractures,  and intracranial hemorrhage caused by birth trauma.NURS 378 Clinical Case Study GRADING CRITERIA.

To minimize the incidence of shoulder dystocia fetal criteria, a detailed examination should be carried out using palpating and ultrasound of the abdomen of the mother, so that the weight and size of the infant can be measured(Huntley and  Smith, 2017). If it is estimated that the fetal weight is 4500 g or more, cesarean birth is generally advised. The preferred method of birth with an average fetal weight of about 4000 to 4500 g is questionable.NURS 378 Clinical Case Study GRADING CRITERIA.

When dystocia is presumed, the mother must be advised to push her legs wide apart. The nurse should clarify to the mother that the baby’s shoulders are complicated to get out, and also that she has to push hard to get out of the shoulders. Adjusting the position of the mother to her hands and knees may help deliver the infant. This being an emergency procedure, the individual may be aided into the McRoberts maneuver (Lok, Cheng, and  Leung, 2016).This is sharp flexion of the thigh towards the hips and abdomen, or the application a soft suprapubic pressure in an attempt to facilitate the birth of the fetal shoulders.NURS 378 Clinical Case Study GRADING CRITERIA.

Rubin II may be introduced, which involves placing the fingertips of one hand vaginally, behind the back of the anterior shoulder of the baby, and turning the shoulder towards the fetal chest. This movement is applied to the fetal shoulder girdle, which decreases its diameter. If the Rubin II technique is ineffective, the Woods corkscrew maneuver can be attempted(Huntley and  Smith, 2017). The surgeon puts two fingers specifically on the anterior aspect of the fetal posterior shoulder, applying delicate upward pressure along the diameter of the arc in the same orientation as Rubin II. This movement allows a more stable rotation.NURS 378 Clinical Case Study GRADING CRITERIA.

Conclusion

Careful monitoring of the infant should be carried out for the determination of any injuries and potential complications until the child is delivered. The infant should be carefully watched for signs of brain, neurological, and motor disorders. The mother should be assisted and presented with information on the issues involved with shoulder dystocia. It should be inspected for complications with the uterus, since it could be overstretched but might not contract well. If the fundus is unstable, so uterine atony is assumed and can be gently massaged to induce uterine contractions as well as avoid bleeding. Vital signs of the baby and the mother should be monitored closely for further assessment.NURS 378 Clinical Case Study GRADING CRITERIA.