Ms. Mohanapriya. S, EXECUTIVE PHYSIOTHERAPIST, Cloudnine Group of Hospitals, CHENNAI (OLD MAHABALLIPURAM ROAD BRANCH)
Gestational diabetes condition in which a hormone made by the placenta prevents the body from using insulin effectively. Glucose builds up in the blood instead of being absorbed by the cells. Hence GDM is associated with increased risk of fetal macrosomia which in turn leads to shoulder dystocia. Through using data from women recruited into routine care group relationship was found between the severity of maternal fasting hyperglycemia and the risk of shoulder dystocia.
SHOULDER DYSTOCIA
Yes of course shoulder dystocia is a birth defect, when fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
Failure of the fetal shoulders to travel the pelvis spontaneously after delivery of the head.
The anterior shoulder becomes trapped behind the symphysis pubis, the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
Over all incidence varies between 0.2 and 1 percent.
PREDISPOSING FACTORS
● Maternal obesity
● Fetal macrosomia
● Obesity
● Mid pelvic instrumental delivery
● Post maturity
● Multiparity
● Anencephaly
● Fetal ascitis
● Breech presentation
● Duration of second stage of labour.
WARNING SIGNS AND DIAGNOSIS
The delivery may have been uncomplicated initially but the head may have advanced slowly and the chin may have had difficulty in sweeping over the perineum.
Once the head is delivered it may look as if it is trying to return into the vaginal which is caused by reverse traction.
Diagnosed when maneuvers normally used by midwife fail to accomplish delivery.
SO WHAT EXACTLY IS SHOULDER DYSTOCIA
NOTHING A COMMON DEFORMITY AND INJURY CAUSED TO BRACHIAL PLEXUS SIMPLY CALL IT AS ERB’S PALSY, HEARD IT A LOT RIGHT.
ERB’S palsy or Erb Duchenne palsy is a form of obstetric brachial plexus injury. Either stretch or rupture or avulse of the roots of the plexus from the spinal cord.
It is the lesion of C5 and C6 nerve roots in some cases C7 is involved as well. Usually produced by widening of the head shoulder interval which affects the cutaneous sensation in the upper limbs depending on the severity of injury, the paralysis can either resolve on its own over a period of months or require rehabilitative therapy or surgery.
PREVENTION
H – ASK FOR PLENTY OF HELP
E – EPISIOTOMY
L – LEGS IN M ROBERTS MANEUVER.
P – SUPRAPUBIC PRESSURE
E – ENTER ROTATIONAL MANEUVER.
R – REMOVE POSTERIOR ARMS
R – ROLL OVER ON TO FOUR LEGS (FLIP FLOP POSITION).
KICO
KNEES IN AND CALFS OUT POSITION
During this position knee is moved in pelvis is making room for the easier transition of the baby’s head through the birth canal.
It works well when it is done in the flip flop position making room for the sacrum to move posterior.
This helps during the second stage of the labor.
MANAGEMENT
First 2 weeks after birth
● careful handling is required and extremes of motion are to be avoided for the first few weeks.
● Allow for initial inflammatory response to calm down.
● Avoid picking a child by the arm or from the armpit of the affected side.
● Placing a child on their back or in side lying with affected limb up to avoid compression of the affected limb.
● Place the affected arm into the sleeves before the unaffected arm. This will avoid extreme movement at the shoulders.
● During the first 6months treatment is directed specifically at prevention of fixed deformities.
● Exercise therapy should be administered daily to maintain ROM and improve muscle strength.
● Parents must be taught to take an active role in maintaining ROM exercises.
● Exercises should be bimanual or bilateral movement, motor planning activities.
CONCLUSION
Hence physiotherapy plays a vital role in managing shoulder dystocia very effectively during birth as well as after birth.
