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Re: Shoulder Dystocia and the "all fours maneuver"From: Dr. Carlos Chase (drchase@caribnet.net)Sun Oct 8 20:51:00 1995
On Fri., 6 Oct. 1995, LMCNM@aol.com wrote: >I have found that it is the movement that helps to dislodge the shoulder. I >generally slip a bedpan under the patients before I turn on all fours and >this has practically eliminated the need to do this. I feel real comfortable >with shoulder dystocia-- can someone give me a magic cure for PP bleeding. > It seems that my well nourished, healthy patients have terrible cases of >atony. Lonnie Morris CNM What struck me about your message was the statement " I feel real comfortable with shoulder dystocia". I would advise caution. This is one obstetric emergency that I fear. It is usually unexpected and requires immediate action to save the baby. If you have never seen anything go wrong with a shoulder dystocia, you are either very skilled or very lucky. In our population, I have seen several cases go wrong, very wrong and this has happened with the highest skilled doctors in attendance of the delivery. What I would also like to know is: how does one turn a patient onto "all fours" on a delivery bed? In response to your question of atony and PPH. Try active management of the 3rd stage of labour in anticipated cases. Dr. Carlos Chase MBBS, DGO Department of Obstetrics and Gynaecology Queen Elizabeth Hospital Bridgetown Barbados E-mail: drchase@caribnet.net
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