Resumen de Plan de cuidados de enfermería post distocia de hombros: caso clínico
Marina Becas Azagra, Inés Blasco Lázaro, María del Carmen Caballero Rodríguez, Andrea Fernández Sancho, Mónica Gregorio Jordán, Claudia Salete García
- español
La distocia de hombros es una urgencia obstétrica no prevenible que consiste en la salida espontánea de los hombros de manera dificultosa y que necesita la ayuda de maniobras obstétricas para poder sacar al feto tras la salida de la cabeza.
El 50% de distocias de hombros ocurren en partos de fetos con peso normal (<4000g).
Algunas de las complicaciones graves que pueden aparecer tras una distocia en el neonato son: fractura de una o ambas clavículas, parálisis del plexo braquial, fractura de húmero, incluso el fallecimiento.
Paciente de 29 años, primigesta, 39+6 semanas de gestación, acude a urgencias de maternidad por sensación de pérdida de líquido de 4 horas de evolución. Peso fetal estimado: 3.800g hace 4 días, diagnosticado de Grande para la edad gestacional (GEG).
Se decide ingresar en planta para dejar evolucionar, al ver que sigue sin contracciones uterinas se decide empezar pre inducción al parto con método farmacológico con prostaglandinas (propess).
En paritorio una vez puesta la analgesia epidural, se coloca el monitor para tener un registro cardio-tocográfico de manera continua.
Se observa que las contracciones siguen siendo irregulares y espaciadas, se decide comenzar con la perfusión de oxitocina intravenosa según protocolo.
Tras 7 horas de dinámica regular y registro tranquilizador, la gestante se encuentra en dilatación completa, OIDA y en I plano de Hodge.
Se empiezan con los pujos dirigidos con la matrona y tras un par de horas sale la cabeza fetal, presentando una retracción de la misma hacia atrás, lo que se le llama “signo de la tortuga”.
- English
Shoulder dystocia is a non-preventable obstetric emergency that consists of the spontaneous emergence of the shoulders in a difficult manner and that requires the help of obstetric maneuvers to be able to remove the fetus after the exit of the head.
50% of shoulder dystocias occur in deliveries of fetuses with normal weight (<4000g).
Some of the serious complications that can appear after dystocia in the newborn are: fracture of one or both clavicles, brachial plexus paralysis, fracture of the humerus, and even death.
A 29-year-old patient, primigravida, 39+6 weeks of gestation, went to the maternity emergency room due to a sensation of fluid loss that had been going on for 4 hours. Estimated fetal weight: 3,800g 4 days ago, diagnosed as Large for Gestational Age (LEG).
It was decided to enter the ward to let it evolve, seeing that there were still no uterine contractions, it was decided to start pre-induction of labor with a pharmacological method with prostaglandins (propess).
In the delivery room, once epidural analgesia is administered, the monitor is placed to have a continuous cardio-tocographic record.
It was decided to enter the ward to let it evolve, seeing that there were still no uterine contractions, it was decided to start pre-induction of labor with a pharmacological method with prostaglandins (propess).
It is observed that the contractions continue to be irregular and spaced apart, it is decided to begin the intravenous oxytocin infusion according to protocol.
After 7 hours of regular dynamics and reassuring recording, the pregnant woman is in complete dilation, OIDA and in Hodge plane I.
They begin with pushing directed by the midwife and after a couple of hours the fetal head emerges, presenting a retraction of it backwards, which is called “turtle sign”.
