Lecture role in obstetrics

2021-03-18 12:00 AM

The role does not have a birth control mechanism if the pregnancy is full term. But if the fetus is too small or the fetus dies while still preterm, with a wide pelvis, the fetus can push out

General perception

The shoulder is also known as the horizontal throne. The fetus is not located along the axis of the uterus, but horizontally. During labor, the shoulder will appear before the upper waist, one pole is located in the right or left pelvic fossa, and the other is located below the rib.

A throne is a throne with a buttock located on one side of the pit.

The landmark of the shoulder is the shoulder.

Is a rare throne. The rate of 3/1000, is an abnormal throne, has no birth mechanism, can not give birth to the lower sugar while still living, full term. Only able to give birth when qualified for internal rotation of the fetus turns the shoulder into a buttock, or the small fetus has died long.


On the mother's side

The womb gives birth many times to make the uterus loose, the fetus is in a horizontal position, unable to rotate to a vertical position.

The comparison has a deformed uterus such as the 2-horn uterus, the uterus has a septum, the uterus has fibroids.

May be due to the narrow pelvis, tumor striker.

On the part of the fetus

In twins, the first fetus is low, the uterus is wide, the second is not well adjusted, and is in a horizontal position.

Preterm pregnancy, or stillbirth, has no correction between the fetus and the uterus.

About the fetal side

Poly amniotic fluid, the fetal position in the uterus is not fixed.

A striker or short vegetable cord prevents the fetus from being in a vertical position.


Implementing the quadrants

During pregnancy:

There is a history of shoulder birth, has found a malformed uterus, bipolar horn or striker tumor.

Looking at the uterus broadly.

Palpation: the head or buttocks cannot be seen on the joint, the hollow sub-frame, otherwise, the two sides of the pelvis will see the head or buttocks. Between the two poles of the head and the buttocks, it will be flat, that is the back (if the back is in the front), or the amputation of limbs (if the back is behind).

Hear the fetal heart clearly if the back lies first. The back is harder to hear.

Vaginal visit: very high throne, hollow sub-frame.

During labor:

Manipulation due to a contraction of the uterus, manipulation of the absence of contraction will see the signs, as described above.

Vaginal examination: if the amniotic fluid has not been broken and sees the bulging of the amniotic fluid, be careful to avoid rupture of the amniotic fluid. Sometimes you can feel a hand of the fetus sticking out of the uterus, prolapse in the vagina or out of the vulva. Thumb signs: place a fetal hand on the back, thumb pointing at mother's thigh, if pointing at left thigh, the fetal hand is left hand, if pointing at the right thigh, the fetal hand is right hand.

Diagnosis of substitution and substitution pattern:

Do not rely on the fetal back for such diagnosis because whether the shoulder is on the right side or the left side, the fetal back can be in the front or back.

Often based on the side of the reincarnation, ie the shoulder on that side to make a diagnosis.

According to the position of the shoulder blade in which position the sub-frame has 4 types of posture: the left pelvic shoulder first, the right hip shoulder, the right pelvis shoulder first, the left pelvis shoulder.

Diagnosis of substitution pattern is based on 3 factors:

Head on the left or right side.

The name of the protruding fetal shoulder or arm.

Back front or back.

Actually, just 2 factors is enough. Can only rely on head and back or shoulders and back to guess.

For example: the left head, the front back is the left frontal pelvis. Right head, back is right posterior pelvis.

Differential diagnosis

Head : when visiting the vagina to feel the limbs, to find out if there is a head in the upper waist. With the shoulder not touching the head.

Full buttock: when the vagina is palpable, but in the buttocks, the tip of the sacrum is palpable. In the shoulder felt the armpit and ribs.

If in doubt, ultrasound and X-ray can be used.

Spawning mechanism

The role does not have a birth control mechanism if the pregnancy is full term. But if the fetus is too small or the fetus dies at a premature age with wide pelvis, the fetus can be pushed out. The fetus usually folds its body in half with the shoulders and back down first, then the buttocks falling and falling. After the butt is finished, the rest of the fetus will be numbered as in the buttocks, at the top of the last book. Spawning by folding fetal body, only happens when the fetus is dead for a long time, the soft parts, the body will fold easily.

Progression and prognosis

If the role is not detected and handled in time, it will lead to a clinical pregnancy called a floating shoulder. That means the shoulder is not monitored, the rupture, the uterus contractes tightly against the fetus, leading to a threatening condition of rupture of the uterus and a rupture of the uterus that is life-threatening for both mother and child.

If the role is diagnosed and handled in time, the above complications will be avoided, except in the case of premature pregnancy, dying, can give birth under the mechanism described above.

Treatment attitude

During pregnancy

Pregnant women must be examined periodically, especially in the last 3 months of pregnancy, if the horizontal position is detected, pregnant women must be managed by medical facilities with surgical conditions and closely monitored. An ectopic rotation is not instituted and is not performed.

During labor

Management attitude depends on 3 factors:

Amniotic fluid.

Fetal mobility.

There is no pregnancy failure.

Two situations are posed:

For comparison with signs of labor.

Big womb.

The womb has a history of heavy obstetrics and is a rare and precious child.

The rupture of the amniotic membrane, the easy prolapse of the vegetable cord, sa chi should be examined immediately and emergency management.

Striker vegetables, uterus deformity.

If the fetus is dead: abortion only when the baby is qualified, the fetus is low, the fetus's neck is under the uterus is not prolonged, the cervix is ​​fully opened to be able to pull down easily.

For cases of abortion difficult, ineligible, physicians have no experience in performing the procedure, a cesarean section is required even though the fetus is dead.

In case of amniotic fluid infection, caesarean section should pay attention to insert good gauze to prevent peritonitis after cesarean section, for high dose antibiotics, if many children should have partial hysterectomy.

If the uterus ruptures, a cesarean section is required, then depending on the conditions that the uterine preservation stage or partial hysterectomy. Check for bladder, rectal injury, tear, suture and right urethrectomy.


Purpose: Turn horizontal into vertical ones with the conditions:

Oh not broken.

The pregnancy can be rotated.

Normal pelvis.

There are no strikers.

Vegetable sticking to the normal position.

At the surgical facility for timely treatment of complications.

Experienced doctor.